{ "hospital_name": "Bridgton Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Bridgton Hospital" ], "hospital_address": [ "10 Hospital Drive, Bridgton, ME 04009" ], "license_information": { "license_number": "39713", "state": "ME" }, "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": "Allen Stefanek" }, "type_2_npi": [ "1154370153" ], "standard_charge_information": [ { "description": "Hydromorphone HCl Preservative Free (PF) Inj 10 MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00703011303", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 23.73, "10th_percentile": 23.73, "90th_percentile": 23.73, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 14.5, "10th_percentile": 13.81, "90th_percentile": 14.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "1 through 10" } ] } ] }, { "description": "Topiramate Level", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.25, "discounted_cash": 52.0, "minimum": 50.475, "maximum": 152.6027, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 98.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 158.75, "10th_percentile": 158.75, "90th_percentile": 158.75, "count": "1 through 10" } ] } ] }, { "description": "Methylphenidate and Metabolite, Urine", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.25, "discounted_cash": 94.0, "minimum": 87.59, "maximum": 275.9547, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 222.14, "10th_percentile": 222.14, "90th_percentile": 222.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 129.15, "10th_percentile": 129.15, "90th_percentile": 136.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 99.31, "10th_percentile": 93.68, "90th_percentile": 99.31, "count": "26" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.59 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 182.53, "10th_percentile": 182.53, "90th_percentile": 182.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 203.09, "10th_percentile": 195.25, "90th_percentile": 203.09, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 287.0, "10th_percentile": 287.0, "90th_percentile": 304.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 304.25, "10th_percentile": 287.0, "90th_percentile": 304.25, "count": "361" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 91.84, "10th_percentile": 91.84, "90th_percentile": 97.36, "count": "19" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.36, "10th_percentile": 91.84, "90th_percentile": 97.36, "count": "24" } ] } ] }, { "description": "MNT Reassess", "code_information": [ { "code": "97803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.5, "discounted_cash": 18.0, "minimum": 18.15, "maximum": 54.8735, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 184.21, "10th_percentile": 95.88, "90th_percentile": 276.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 84.38, "10th_percentile": 56.25, "90th_percentile": 107.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 121.33, "10th_percentile": 80.88, "90th_percentile": 248.4, "count": "18" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.84, "10th_percentile": 38.84, "90th_percentile": 61.2, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 150.0, "10th_percentile": 100.0, "90th_percentile": 243.65, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.04, "10th_percentile": 19.04, "90th_percentile": 57.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 64.14, "10th_percentile": 21.38, "90th_percentile": 64.14, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 80.22, "10th_percentile": 52.94, "90th_percentile": 132.35, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 170.06, "10th_percentile": 113.38, "90th_percentile": 453.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.12, "10th_percentile": 19.04, "90th_percentile": 100.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.08, "10th_percentile": 38.08, "90th_percentile": 76.16, "count": "1 through 10" } ] } ] }, { "description": "77295 F 3D RADIATION PLAN", "code_information": [ { "code": "77295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6462.5, "discounted_cash": 2003.0, "minimum": 1871.7, "maximum": 5861.4875, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1871.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2534.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2534.37 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15240.0, "minimum": 15240.22, "maximum": 56925.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56925.45 } ] } ] }, { "description": "U Citrate, 24 Hour", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.0, "discounted_cash": 139.0, "minimum": 134.7, "maximum": 407.243, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 259.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 177.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.14 } ] } ] }, { "description": "Heparin Sodium (Porcine) Inj 5000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409272330", "type": "NDC" }, { "code": "J1644", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 15.49, "10th_percentile": 15.49, "90th_percentile": 75.59, "count": "1 through 10" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "257", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 12875.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12875.92 } ] } ] }, { "description": "XR Chest 2 Views 71046", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.25, "discounted_cash": 79.0, "minimum": 76.575, "maximum": 231.5118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 169.74, "10th_percentile": 169.74, "90th_percentile": 169.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 114.86, "10th_percentile": 114.86, "90th_percentile": 114.86, "count": "69" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.31, "10th_percentile": 83.31, "90th_percentile": 83.31, "count": "63" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 169.57 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 104.65, "10th_percentile": 104.65, "90th_percentile": 104.65, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 204.3, "10th_percentile": 200.45, "90th_percentile": 204.3, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 130.83, "10th_percentile": 81.68, "90th_percentile": 188.01, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 197.56, "10th_percentile": 197.56, "90th_percentile": 197.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 255.25, "10th_percentile": 255.25, "90th_percentile": 255.25, "count": "332" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "221" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 203.64, "10th_percentile": 81.68, "90th_percentile": 233.81, "count": "42" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "135" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "50" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "19" } ] } ] }, { "description": "SLP Swallow Function Study Units", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 425.25, "discounted_cash": 131.0, "minimum": 95.0, "maximum": 385.7018, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 329.14, "10th_percentile": 329.14, "90th_percentile": 329.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 191.36, "10th_percentile": 191.36, "90th_percentile": 191.36, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 61.22, "10th_percentile": 61.22, "90th_percentile": 61.22, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.08, "10th_percentile": 136.08, "90th_percentile": 136.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.08, "10th_percentile": 136.08, "90th_percentile": 136.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.08, "10th_percentile": 136.08, "90th_percentile": 136.08, "count": "1 through 10" } ] } ] }, { "description": "XR ERCP Pancreatic", "code_information": [ { "code": "74329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2007.5, "discounted_cash": 622.0, "minimum": 271.33, "maximum": 1820.8025, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 271.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 367.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 367.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 360.96 } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "828", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 20086.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20086.06 } ] } ] }, { "description": "Ondansetron HCl Inj 4 MG/2ML (2 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "23155054831", "type": "NDC" }, { "code": "J2405", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 11.86, "10th_percentile": 11.86, "90th_percentile": 11.86, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.9, "10th_percentile": 12.9, "90th_percentile": 12.9, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 13.81, "10th_percentile": 6.03, "90th_percentile": 14.5, "count": "1 through 10" } ] } ] }, { "description": "Platelet Associated Ab, IgG", "code_information": [ { "code": "86023", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 678.75, "discounted_cash": 210.0, "minimum": 79.7, "maximum": 615.6263, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.15 } ] } ] }, { "description": "XR Lumbar Sp Min 4-5V", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703.5, "discounted_cash": 218.0, "minimum": 153.18, "maximum": 638.0745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 539.58, "10th_percentile": 539.58, "90th_percentile": 539.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 153.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 207.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 229.62, "10th_percentile": 229.62, "90th_percentile": 229.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 207.41 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 422.15, "10th_percentile": 422.15, "90th_percentile": 422.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 531.27, "10th_percentile": 531.27, "90th_percentile": 531.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 397.53, "10th_percentile": 397.53, "90th_percentile": 397.53, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 703.5, "10th_percentile": 663.75, "90th_percentile": 703.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 218.09, "10th_percentile": 212.4, "90th_percentile": 225.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 225.12, "10th_percentile": 212.4, "90th_percentile": 608.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 225.12, "10th_percentile": 225.12, "90th_percentile": 225.12, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 8800.69, "maximum": 13714.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13714.12 } ] } ] }, { "description": "Done - Newborn Hepatitis B Vaccine", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.5, "discounted_cash": 6.0, "minimum": 6.45, "maximum": 19.5005, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.64, "count": "24" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.68, "10th_percentile": 9.68, "90th_percentile": 9.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 14.24, "10th_percentile": 8.51, "90th_percentile": 14.61, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 7.02, "10th_percentile": 7.02, "90th_percentile": 7.02, "count": "14" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 17.61, "10th_percentile": 17.2, "90th_percentile": 17.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 17.15, "10th_percentile": 17.15, "90th_percentile": 17.15, "count": "15" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 16.64, "10th_percentile": 16.64, "90th_percentile": 16.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 21.5, "10th_percentile": 21.5, "90th_percentile": 21.5, "count": "401" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "1 through 10" } ] } ] }, { "description": "Chromosome FISH, CLL Panel", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 985.25, "discounted_cash": 305.0, "minimum": 137.01, "maximum": 893.6218, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 200.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.01 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 297.44, "10th_percentile": 297.44, "90th_percentile": 297.44, "count": "1 through 10" } ] } ] }, { "description": "XR Intro LG GI Tube w/Films", "code_information": [ { "code": "74340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 485.75, "discounted_cash": 150.0, "minimum": 145.725, "maximum": 485.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 417.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 485.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 485.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.75 } ] } ] }, { "description": "75600 FAC CNTRST X-RAY EXM OF AORTA", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7088.25, "discounted_cash": 2197.0, "minimum": 1197.69, "maximum": 6429.0427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1197.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1621.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1621.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1348.02 } ] } ] }, { "description": "Lipoprotein (a)", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 63.0, "minimum": 61.2, "maximum": 196.5925, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 99.11 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 160.2, "10th_percentile": 160.2, "90th_percentile": 160.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 133.5, "10th_percentile": 43.75, "90th_percentile": 385.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.28, "10th_percentile": 42.72, "90th_percentile": 65.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 349.88, "10th_percentile": 349.88, "90th_percentile": 349.88, "count": "1 through 10" } ] } ] }, { "description": "PUNC ASP ABSCESS FAC", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.25, "discounted_cash": 101.0, "minimum": 98.475, "maximum": 297.7228, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 328.25, "10th_percentile": 328.25, "90th_percentile": 328.25, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "622", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18459.0, "minimum": 18459.99, "maximum": 41959.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41959.34 } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC", "code_information": [ { "code": "492", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14166.0, "minimum": 14166.97, "maximum": 43284.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43284.42 } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC", "code_information": [ { "code": "420", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14810.0, "minimum": 14810.92, "maximum": 40166.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40166.23 } ] } ] }, { "description": "PENIS PROCEDURES WITH CCMCC", "code_information": [ { "code": "709", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 27434.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27434.14 } ] } ] }, { "description": "U Cadmium, 24HR", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 18.0, "minimum": 18.3, "maximum": 61.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.0 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [ { "code": "083", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 16455.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16455.06 } ] } ] }, { "description": "Albumin,Serum", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.25, "discounted_cash": 11.0, "minimum": 10.875, "maximum": 36.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 24.11, "10th_percentile": 24.11, "90th_percentile": 24.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.31, "10th_percentile": 16.31, "90th_percentile": 16.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.83, "10th_percentile": 11.83, "90th_percentile": 11.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 23.06, "10th_percentile": 23.06, "90th_percentile": 23.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 27.06, "10th_percentile": 27.06, "90th_percentile": 27.06, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 36.25, "10th_percentile": 36.25, "90th_percentile": 36.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "count": "1 through 10" } ] } ] }, { "description": "SLP Use,Fit Speech Prosthetic Eval Units", "code_information": [ { "code": "92597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.0, "discounted_cash": 108.0, "minimum": 95.0, "maximum": 318.357, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CT Lumbar Spine w Contrast", "code_information": [ { "code": "72132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2085.75, "discounted_cash": 646.0, "minimum": 625.725, "maximum": 1891.7752, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1526.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1526.93 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 984.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1967.75, "10th_percentile": 1967.75, "90th_percentile": 1967.75, "count": "1 through 10" } ] } ] }, { "description": "SIM REP FACE 5.1-7.5 FAC", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 361.75, "discounted_cash": 112.0, "minimum": 108.525, "maximum": 328.1073, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 284.08, "10th_percentile": 284.08, "90th_percentile": 284.08, "count": "1 through 10" } ] } ] }, { "description": "XR Shoulder Left Complete", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430.0, "discounted_cash": 133.0, "minimum": 81.71, "maximum": 390.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 269.82, "10th_percentile": 269.82, "90th_percentile": 269.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 182.59, "10th_percentile": 182.59, "90th_percentile": 193.5, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 140.35, "10th_percentile": 132.44, "90th_percentile": 140.35, "count": "14" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 273.48, "10th_percentile": 258.06, "90th_percentile": 704.34, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 337.68, "10th_percentile": 324.76, "90th_percentile": 337.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 211.52, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 269.82, "10th_percentile": 269.82, "90th_percentile": 269.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 430.0, "10th_percentile": 405.75, "90th_percentile": 430.0, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 129.84, "10th_percentile": 129.84, "90th_percentile": 137.6, "count": "59" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 390.01, "10th_percentile": 390.01, "90th_percentile": 390.01, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 137.6, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 137.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 129.84, "10th_percentile": 129.84, "90th_percentile": 137.6, "count": "1 through 10" } ] } ] }, { "description": "Beta Strep AST-01 Systemic", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.5, "discounted_cash": 38.0, "minimum": 37.65, "maximum": 113.8285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 78.8, "10th_percentile": 78.8, "90th_percentile": 96.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.33, "10th_percentile": 53.33, "90th_percentile": 53.33, "count": "34" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.68, "10th_percentile": 38.68, "90th_percentile": 77.36, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.29 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 75.37, "10th_percentile": 75.37, "90th_percentile": 100.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 94.85, "10th_percentile": 93.06, "90th_percentile": 94.85, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.5, "10th_percentile": 17.23, "90th_percentile": 118.5, "count": "19" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 90.89, "10th_percentile": 90.89, "90th_percentile": 90.89, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 118.5, "10th_percentile": 118.5, "90th_percentile": 125.5, "count": "83" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.92, "10th_percentile": 8.65, "90th_percentile": 40.16, "count": "109" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 80.63, "10th_percentile": 80.63, "90th_percentile": 80.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.92, "10th_percentile": 37.92, "90th_percentile": 273.05, "count": "57" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.92, "10th_percentile": 37.92, "90th_percentile": 37.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.92, "10th_percentile": 37.92, "90th_percentile": 75.84, "count": "1 through 10" } ] } ] }, { "description": "T3 Resin Uptake", "code_information": [ { "code": "84479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.75, "discounted_cash": 36.0, "minimum": 35.025, "maximum": 105.8923, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.31 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.36, "10th_percentile": 37.36, "90th_percentile": 37.36, "count": "1 through 10" } ] } ] }, { "description": "NM Inflamation Local Limited 78800", "code_information": [ { "code": "78800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1573.0, "discounted_cash": 487.0, "minimum": 471.9, "maximum": 1573.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 595.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 805.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 805.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1573.0 } ] } ] }, { "description": "VL Duplex Scan Abd Viscera Complete - Vascular US Charges", "code_information": [ { "code": "93975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1626.25, "discounted_cash": 504.0, "minimum": 487.875, "maximum": 1475.0087, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 807.31, "10th_percentile": 807.31, "90th_percentile": 807.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 546.3, "10th_percentile": 546.3, "90th_percentile": 546.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 825.16, "10th_percentile": 825.16, "90th_percentile": 852.34, "count": "24" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 1029.4, "10th_percentile": 994.27, "90th_percentile": 1053.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1010.48, "10th_percentile": 825.94, "90th_percentile": 1010.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 968.53, "10th_percentile": 968.53, "90th_percentile": 968.53, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 388.48, "10th_percentile": 388.48, "90th_percentile": 388.48, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 986.94, "10th_percentile": 986.94, "90th_percentile": 986.94, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1214.0, "10th_percentile": 1214.0, "90th_percentile": 1286.75, "count": "38" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 388.48, "10th_percentile": 388.48, "90th_percentile": 411.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1112.02, "10th_percentile": 1112.02, "90th_percentile": 1112.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1167.09, "10th_percentile": 1167.09, "90th_percentile": 1167.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 411.76, "10th_percentile": 411.76, "90th_percentile": 411.76, "count": "1 through 10" } ] } ] }, { "description": "75756 FAC ARTERY X-RAYS, CHEST", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2507.5, "discounted_cash": 777.0, "minimum": 752.25, "maximum": 2274.3025, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 945.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1280.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1280.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 941.91 } ] } ] }, { "description": "Vitamin D, 1,25-Dihydroxy Level", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.75, "discounted_cash": 111.0, "minimum": 107.625, "maximum": 358.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 317.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 246.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 358.75, "10th_percentile": 358.75, "90th_percentile": 358.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 114.8, "10th_percentile": 114.8, "90th_percentile": 114.8, "count": "1 through 10" } ] } ] }, { "description": "CT Temp Bones wo Contrast", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1720.5, "discounted_cash": 533.0, "minimum": 516.15, "maximum": 1560.4935, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 868.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 519.36, "10th_percentile": 519.36, "90th_percentile": 519.36, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1720.5, "10th_percentile": 1720.5, "90th_percentile": 1720.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1560.49, "10th_percentile": 1560.49, "90th_percentile": 1560.49, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 550.56, "10th_percentile": 550.56, "90th_percentile": 550.56, "count": "1 through 10" } ] } ] }, { "description": "NM Brain Imaging Vascular Flow Only", "code_information": [ { "code": "78610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 434.0, "minimum": 420.525, "maximum": 1271.3872, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 628.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 851.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 851.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1254.93 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 9786.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9786.03 } ] } ] }, { "description": "Ectoparasite Identification", "code_information": [ { "code": "87168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.5, "discounted_cash": 10.0, "minimum": 9.75, "maximum": 32.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.5 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 23838.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23838.5 } ] } ] }, { "description": "Ophth Ultrasound B W/Non Quant A", "code_information": [ { "code": "76512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.25, "discounted_cash": 168.0, "minimum": 152.3068, "maximum": 491.8207, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 231.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.31 } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC", "code_information": [ { "code": "511", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7512.0, "minimum": 7512.79, "maximum": 24514.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24514.01 } ] } ] }, { "description": "Adenosine Deaminase, Pleural Fluid", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.0, "discounted_cash": 49.0, "minimum": 44.69, "maximum": 144.213, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.51 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 25869.5084, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20206.31 } ] } ] }, { "description": "CT Ankle Left w+wo Contrast", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1635.25, "discounted_cash": 506.0, "minimum": 490.575, "maximum": 1635.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1635.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1635.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1215.45 } ] } ] }, { "description": "NM Parathyroid Scan", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 673.75, "discounted_cash": 208.0, "minimum": 202.125, "maximum": 673.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 519.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 673.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 673.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 673.75 } ] } ] }, { "description": "$ Basic Metabolic 80048", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.25, "discounted_cash": 56.0, "minimum": 54.16, "maximum": 164.3938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 113.72, "10th_percentile": 113.72, "90th_percentile": 113.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.56, "10th_percentile": 76.95, "90th_percentile": 81.56, "count": "107" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.16, "10th_percentile": 55.81, "90th_percentile": 59.16, "count": "110" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 54.16 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 115.28, "10th_percentile": 115.28, "90th_percentile": 115.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 142.34, "10th_percentile": 136.87, "90th_percentile": 142.34, "count": "39" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.72, "10th_percentile": 8.46, "90th_percentile": 171.0, "count": "29" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 132.35, "10th_percentile": 35.03, "90th_percentile": 278.04, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 181.25, "10th_percentile": 171.0, "90th_percentile": 181.25, "count": "192" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.0, "count": "395" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 164.39, "count": "68" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.0, "count": "229" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.0, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.0, "count": "41" } ] } ] }, { "description": "ABO Rh Type", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.25, "discounted_cash": 15.0, "minimum": 14.775, "maximum": 44.6698, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 38.12, "10th_percentile": 38.12, "90th_percentile": 38.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 22.16, "10th_percentile": 21.04, "90th_percentile": 22.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.08, "10th_percentile": 16.08, "90th_percentile": 16.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 40.34, "10th_percentile": 40.34, "90th_percentile": 40.34, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 39.42, "10th_percentile": 39.42, "90th_percentile": 39.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.25, "10th_percentile": 49.25, "90th_percentile": 49.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 32.75, "10th_percentile": 32.75, "90th_percentile": 32.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 49.25, "10th_percentile": 49.25, "90th_percentile": 49.25, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.76, "10th_percentile": 14.96, "90th_percentile": 15.76, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 44.67, "10th_percentile": 14.96, "90th_percentile": 45.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.76, "10th_percentile": 15.76, "90th_percentile": 15.76, "count": "49" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.76, "10th_percentile": 15.76, "90th_percentile": 15.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.76, "10th_percentile": 15.76, "90th_percentile": 15.76, "count": "1 through 10" } ] } ] }, { "description": "SLP Developmental Testing Units", "code_information": [ { "code": "96110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.25, "discounted_cash": 111.0, "minimum": 95.0, "maximum": 325.8397, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21894.0, "minimum": 21894.4, "maximum": 56637.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56637.8 } ] } ] }, { "description": "88160 AP Bill Non-Gyn Cytology", "code_information": [ { "code": "88160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.75, "discounted_cash": 42.0, "minimum": 41.325, "maximum": 137.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.75 } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [ { "code": "032", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 25122.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25122.32 } ] } ] }, { "description": "U/S Guidance Vasc Access HF US", "code_information": [ { "code": "76937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 569.25, "discounted_cash": 176.0, "minimum": 84.62, "maximum": 516.3098, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 569.25, "10th_percentile": 569.25, "90th_percentile": 569.25, "count": "1 through 10" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH MCC", "code_information": [ { "code": "466", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15240.0, "minimum": 15240.22, "maximum": 61366.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61366.36 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 7898.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7898.62 } ] } ] }, { "description": "LONG ARM SPLINT FAC", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 432.25, "discounted_cash": 133.0, "minimum": 129.675, "maximum": 392.0507, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 432.25, "10th_percentile": 432.25, "90th_percentile": 432.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 411.75, "10th_percentile": 411.75, "90th_percentile": 432.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 377.16, "10th_percentile": 377.16, "90th_percentile": 377.16, "count": "1 through 10" } ] } ] }, { "description": "CT CCTA w+wo Dye Quan Calcium", "code_information": [ { "code": "75574", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1451.25, "discounted_cash": 449.0, "minimum": 435.375, "maximum": 1451.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1451.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1451.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1451.25 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "716", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3434.0, "minimum": 3434.42, "maximum": 17341.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17341.59 } ] } ] }, { "description": "Rad Ther Room Level 2", "code_information": [ { "code": "99212", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 54.0, "minimum": 53.1, "maximum": 160.539, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 63.34, "10th_percentile": 63.34, "90th_percentile": 63.34, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.86, "10th_percentile": 42.86, "90th_percentile": 42.86, "count": "209" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 31.09, "10th_percentile": 31.09, "90th_percentile": 31.09, "count": "133" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.25, "10th_percentile": 69.03, "90th_percentile": 95.25, "count": "123" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 37.47, "10th_percentile": 36.86, "90th_percentile": 37.47, "count": "1975" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 30.48, "count": "643" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 136.81, "10th_percentile": 30.48, "90th_percentile": 176.35, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.88, "10th_percentile": 30.48, "90th_percentile": 176.35, "count": "309" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 36.4, "count": "56" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 30.48, "count": "67" } ] } ] }, { "description": "NM Bone Scan Whole Body", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1169.5, "discounted_cash": 362.0, "minimum": 350.85, "maximum": 1169.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 812.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1100.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1100.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1169.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 374.24, "10th_percentile": 374.24, "90th_percentile": 374.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 374.24, "10th_percentile": 374.24, "90th_percentile": 374.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 374.24, "10th_percentile": 374.24, "90th_percentile": 374.24, "count": "1 through 10" } ] } ] }, { "description": "Coagulation Time, Activated", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.75, "discounted_cash": 14.0, "minimum": 14.025, "maximum": 42.4023, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.9 } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC", "code_information": [ { "code": "625", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 35603.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35603.9 } ] } ] }, { "description": "Mycophenolic Acid Level", "code_information": [ { "code": "80180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.0, "discounted_cash": 57.0, "minimum": 55.8, "maximum": 168.702, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.52, "10th_percentile": 59.52, "90th_percentile": 59.52, "count": "1 through 10" } ] } ] }, { "description": "ASP INJECT MAJOR JT FAC", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.5, "discounted_cash": 292.0, "minimum": 283.05, "maximum": 855.7545, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 424.58, "10th_percentile": 424.58, "90th_percentile": 424.58, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 286.12, "10th_percentile": 286.12, "90th_percentile": 286.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 943.5, "10th_percentile": 943.5, "90th_percentile": 943.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 301.92, "10th_percentile": 301.92, "90th_percentile": 301.92, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH MCC", "code_information": [ { "code": "183", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9015.0, "minimum": 9015.34, "maximum": 18035.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18035.96 } ] } ] }, { "description": "Clonazepam (Klonopin) Level - 80346 - 3358706", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.25, "discounted_cash": 87.0, "minimum": 84.675, "maximum": 256.0007, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.17 } ] } ] }, { "description": "Worm ID", "code_information": [ { "code": "87169", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.5, "discounted_cash": 23.0, "minimum": 22.95, "maximum": 69.3855, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.48, "10th_percentile": 24.48, "90th_percentile": 24.48, "count": "1 through 10" } ] } ] }, { "description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC", "code_information": [ { "code": "605", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 10798.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10798.71 } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC", "code_information": [ { "code": "021", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10517.0, "minimum": 10517.9, "maximum": 62408.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62408.5 } ] } ] }, { "description": "U VMA", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.0, "discounted_cash": 66.0, "minimum": 64.5, "maximum": 195.005, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 99.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.48 } ] } ] }, { "description": "HSV Type 2 Glycoprotein IgG", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.25, "discounted_cash": 77.0, "minimum": 75.375, "maximum": 227.8837, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 251.25, "10th_percentile": 251.25, "90th_percentile": 251.25, "count": "1 through 10" } ] } ] }, { "description": "Platelet", "code_information": [ { "code": "85049", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 18.0, "minimum": 18.3, "maximum": 55.327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 44.51, "10th_percentile": 44.51, "90th_percentile": 46.79, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.88, "10th_percentile": 25.88, "90th_percentile": 25.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 61.0, "10th_percentile": 61.0, "90th_percentile": 61.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.91, "10th_percentile": 18.91, "90th_percentile": 18.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" } ] } ] }, { "description": "XR Forearm Left 2 Views", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.5, "discounted_cash": 108.0, "minimum": 75.84, "maximum": 318.8105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 269.6, "10th_percentile": 269.6, "90th_percentile": 539.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 158.18, "10th_percentile": 158.18, "90th_percentile": 158.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 108.2, "10th_percentile": 108.2, "90th_percentile": 114.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.69 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 265.33, "10th_percentile": 265.33, "90th_percentile": 265.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 249.04, "10th_percentile": 249.04, "90th_percentile": 249.04, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 351.5, "10th_percentile": 331.5, "90th_percentile": 351.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 108.97, "10th_percentile": 106.08, "90th_percentile": 112.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 106.08, "10th_percentile": 106.08, "90th_percentile": 318.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.48, "10th_percentile": 106.08, "90th_percentile": 112.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.48, "10th_percentile": 112.48, "90th_percentile": 112.48, "count": "1 through 10" } ] } ] }, { "description": "Chromosome Analysis, Blood", "code_information": [ { "code": "88237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.0, "discounted_cash": 273.0, "minimum": 201.9, "maximum": 883.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 644.74, "10th_percentile": 644.74, "90th_percentile": 644.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 373.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 255.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 883.0 } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 8488.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8488.07 } ] } ] }, { "description": "US Elastography Parenchyma 76981", "code_information": [ { "code": "76981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.0, "discounted_cash": 168.0, "minimum": 162.6, "maximum": 542.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.0 } ] } ] }, { "description": "MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES", "code_information": [ { "code": "483", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 32677.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32677.87 } ] } ] }, { "description": "PSYCHOSES", "code_information": [ { "code": "885", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13952.0, "minimum": 13952.32, "maximum": 16466.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16466.85 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18889.0, "minimum": 18889.29, "maximum": 41112.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41112.89 } ] } ] }, { "description": "HIV 1,2 Ab - G0432 - 3358933", "code_information": [ { "code": "G0432", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "minimum": 27.375, "maximum": 91.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.7, "10th_percentile": 38.7, "90th_percentile": 38.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 29.2, "count": "1 through 10" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 13409.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13409.96 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [ { "code": "264", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14381.0, "minimum": 14381.62, "maximum": 39382.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39382.27 } ] } ] }, { "description": "CT Temp Bones w+wo Contrast", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2012.25, "discounted_cash": 623.0, "minimum": 603.675, "maximum": 1866.73, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1866.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1866.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1328.28 } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [ { "code": "406", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 34190.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34190.4 } ] } ] }, { "description": "$ AP 88314 Histochemical Stain", "code_information": [ { "code": "88314", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 54.0, "minimum": 52.5, "maximum": 175.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.0 } ] } ] }, { "description": "MRI Breast Bx Clip Perc EA Add Lesion 19288", "code_information": [ { "code": "19288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2042.5, "discounted_cash": 633.0, "minimum": 612.75, "maximum": 1852.5475, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "NM Kidney Funct Non-Imaging Study", "code_information": [ { "code": "78725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 708.5, "discounted_cash": 219.0, "minimum": 212.55, "maximum": 676.8431, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 320.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 434.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 434.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 676.84 } ] } ] }, { "description": "Interleukin 6, Serum", "code_information": [ { "code": "83529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.0, "discounted_cash": 80.0, "minimum": 78.0, "maximum": 235.82, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 260.0, "10th_percentile": 260.0, "90th_percentile": 260.0, "count": "1 through 10" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC", "code_information": [ { "code": "070", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 19626.29, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19626.29 } ] } ] }, { "description": "Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281021515", "type": "NDC" }, { "code": "90714", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 218.25, "10th_percentile": 218.25, "90th_percentile": 218.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.84, "10th_percentile": 69.84, "90th_percentile": 74.0, "count": "1 through 10" } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "759", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 7823.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7823.17 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "502", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 15866.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15866.79 } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "328", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 18889.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18889.48 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 9857.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9857.95 } ] } ] }, { "description": "Vitamin K1 Level", "code_information": [ { "code": "84597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.25, "discounted_cash": 59.0, "minimum": 57.675, "maximum": 174.3707, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 192.25, "10th_percentile": 192.25, "90th_percentile": 192.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 61.52, "10th_percentile": 61.52, "90th_percentile": 61.52, "count": "1 through 10" } ] } ] }, { "description": "SLP Non-Speech AAC Device Eval Units", "code_information": [ { "code": "92605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.5, "discounted_cash": 158.0, "minimum": 95.0, "maximum": 463.0235, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 29845.5182, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 8156.74, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 23447.05, "10th_percentile": 23447.05, "90th_percentile": 27710.15, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8523.78, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9283.78, "10th_percentile": 2972.96, "90th_percentile": 59943.29, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8156.74, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17052.4, "10th_percentile": 6394.65, "90th_percentile": 31973.25, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13275.57 } ] } ] }, { "description": "Trich vag RNA, Ql, TMA, Males", "code_information": [ { "code": "87661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.5, "discounted_cash": 91.0, "minimum": 88.35, "maximum": 294.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 200.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 155.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 294.5 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 10263.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10263.49 } ] } ] }, { "description": "ChrA BM", "code_information": [ { "code": "88237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 673.0, "discounted_cash": 273.0, "minimum": 201.9, "maximum": 883.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 373.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 255.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 673.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 203.2, "10th_percentile": 203.2, "90th_percentile": 203.2, "count": "1 through 10" } ] } ] }, { "description": "NM Liver Scan w Flow", "code_information": [ { "code": "78202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.5, "discounted_cash": 160.0, "minimum": 154.95, "maximum": 516.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 516.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 516.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 516.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 516.5 } ] } ] }, { "description": "Specific Gravity, Urine", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 17.0, "minimum": 16.39, "maximum": 49.885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.73, "10th_percentile": 13.73, "90th_percentile": 13.73, "count": "36" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.96, "10th_percentile": 9.96, "90th_percentile": 9.96, "count": "19" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.5, "10th_percentile": 30.5, "90th_percentile": 30.5, "count": "13" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 30.5, "10th_percentile": 30.5, "90th_percentile": 30.5, "count": "81" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.76, "10th_percentile": 9.76, "90th_percentile": 9.76, "count": "60" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 146.57, "10th_percentile": 146.57, "90th_percentile": 146.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 104.92, "10th_percentile": 9.76, "90th_percentile": 146.57, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.76, "10th_percentile": 9.76, "90th_percentile": 9.76, "count": "1 through 10" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 8511.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8511.64 } ] } ] }, { "description": "ED US EXAM CHEST FAC", "code_information": [ { "code": "76604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.25, "discounted_cash": 133.0, "minimum": 128.775, "maximum": 389.3297, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 733.0, "10th_percentile": 733.0, "90th_percentile": 733.0, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 13206.6864, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11379.9 } ] } ] }, { "description": "U Chloride", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.0, "discounted_cash": 22.0, "minimum": 21.3, "maximum": 64.397, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.6 } ] } ] }, { "description": "Bartonella sp by PCR", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1217.25, "discounted_cash": 377.0, "minimum": 166.63, "maximum": 1104.0457, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09 } ] } ] }, { "description": "Vitamin A (retinol)", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.25, "discounted_cash": 49.0, "minimum": 47.775, "maximum": 144.4398, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.18 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 101.28, "10th_percentile": 101.28, "90th_percentile": 101.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 127.46, "10th_percentile": 127.46, "90th_percentile": 127.46, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 159.25, "10th_percentile": 159.25, "90th_percentile": 159.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 50.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 50.96, "count": "1 through 10" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH CC", "code_information": [ { "code": "975", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 15266.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15266.73 } ] } ] }, { "description": "Gram Stain", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.5, "discounted_cash": 21.0, "minimum": 20.85, "maximum": 63.0365, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 42.89, "10th_percentile": 42.89, "90th_percentile": 42.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.71, "10th_percentile": 29.03, "90th_percentile": 87.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 21.05, "10th_percentile": 21.05, "90th_percentile": 44.55, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 43.41, "10th_percentile": 43.41, "90th_percentile": 109.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 53.6, "10th_percentile": 51.63, "90th_percentile": 206.5, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.5, "10th_percentile": 64.5, "90th_percentile": 68.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 68.25, "10th_percentile": 64.5, "90th_percentile": 136.5, "count": "44" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.64, "10th_percentile": 4.27, "90th_percentile": 41.28, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 54.45, "10th_percentile": 21.84, "90th_percentile": 62.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 21.84, "10th_percentile": 20.64, "90th_percentile": 65.52, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.64, "10th_percentile": 20.64, "90th_percentile": 20.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 21.84, "10th_percentile": 20.64, "90th_percentile": 41.28, "count": "1 through 10" } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC", "code_information": [ { "code": "629", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 12664.41, "maximum": 25685.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25685.83 } ] } ] }, { "description": "CT Simulation Complex", "code_information": [ { "code": "77290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2019.5, "discounted_cash": 626.0, "minimum": 605.85, "maximum": 2019.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1671.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2019.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2019.5 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18674.0, "minimum": 18674.64, "maximum": 79352.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79352.8 } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC", "code_information": [ { "code": "098", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 8796.4742, "maximum": 27054.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27054.53 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 9057.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9057.47 } ] } ] }, { "description": "XR Tomography", "code_information": [ { "code": "76100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 642.25, "discounted_cash": 199.0, "minimum": 192.675, "maximum": 582.5208, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 406.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 406.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 524.54 } ] } ] }, { "description": "CT Cervical Spine wo Contrast", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1705.5, "discounted_cash": 528.0, "minimum": 511.65, "maximum": 1546.8885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1308.12, "10th_percentile": 654.06, "90th_percentile": 1320.06, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 767.48, "10th_percentile": 383.74, "90th_percentile": 767.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 525.18, "10th_percentile": 525.18, "90th_percentile": 556.68, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1287.84, "10th_percentile": 1287.84, "90th_percentile": 1339.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 733.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1705.5, "10th_percentile": 1609.0, "90th_percentile": 1705.5, "count": "33" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 545.76, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 545.76, "10th_percentile": 545.76, "90th_percentile": 1283.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 545.76, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 545.76, "10th_percentile": 545.76, "90th_percentile": 545.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 545.76, "count": "1 through 10" } ] } ] }, { "description": "Saccharomyces cerevisiae IgA", "code_information": [ { "code": "86671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.0, "discounted_cash": 45.0, "minimum": 44.1, "maximum": 133.329, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.4, "10th_percentile": 88.4, "90th_percentile": 88.4, "count": "1 through 10" } ] } ] }, { "description": "NM First Pass RVEF Add On", "code_information": [ { "code": "78496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 865.25, "discounted_cash": 268.0, "minimum": 160.7758, "maximum": 784.7817, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 370.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 501.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 501.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.78 } ] } ] }, { "description": "$ Renal Panel 80069", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.75, "discounted_cash": 53.0, "minimum": 52.125, "maximum": 157.5913, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 109.06, "10th_percentile": 109.06, "90th_percentile": 109.06, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 78.19, "10th_percentile": 73.8, "90th_percentile": 78.19, "count": "33" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.53, "10th_percentile": 53.53, "90th_percentile": 56.71, "count": "25" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.56 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 110.51, "10th_percentile": 104.3, "90th_percentile": 110.51, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 131.27, "10th_percentile": 131.27, "90th_percentile": 136.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 52.48, "10th_percentile": 27.28, "90th_percentile": 164.0, "count": "17" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 173.75, "10th_percentile": 164.0, "90th_percentile": 173.75, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 55.6, "10th_percentile": 52.48, "90th_percentile": 55.6, "count": "116" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 55.6, "10th_percentile": 52.48, "90th_percentile": 157.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 55.6, "10th_percentile": 52.48, "90th_percentile": 55.6, "count": "54" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 52.48, "10th_percentile": 52.48, "90th_percentile": 55.6, "count": "1 through 10" } ] } ] }, { "description": "Hepatitis C RNA (Quant, RT-PCR)", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 474.5, "discounted_cash": 147.0, "minimum": 142.35, "maximum": 430.3715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 346.56, "10th_percentile": 346.56, "90th_percentile": 346.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 138.23, "10th_percentile": 138.23, "90th_percentile": 138.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 474.5, "10th_percentile": 423.5, "90th_percentile": 474.5, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 151.84, "10th_percentile": 135.52, "90th_percentile": 151.84, "count": "1 through 10" } ] } ] }, { "description": "INTRO NEEDLE VEIN FAC", "code_information": [ { "code": "36000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.5, "discounted_cash": 33.0, "minimum": 32.55, "maximum": 98.4095, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 108.5, "10th_percentile": 108.5, "90th_percentile": 108.5, "count": "1 through 10" } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [ { "code": "872", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 17946.1989, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 15176.11, "standard_charge_algorithm": "76.7% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 24020.88, "10th_percentile": 24020.88, "90th_percentile": 24020.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7626.54, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12410.21, "10th_percentile": 12410.21, "90th_percentile": 16225.95, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7298.13, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4263.1, "10th_percentile": 2291.58, "90th_percentile": 6874.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 7298.13, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6945.0, "10th_percentile": 6945.0, "90th_percentile": 9192.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12063.66 } ] } ] }, { "description": "Bill HLA Antibody Screen", "code_information": [ { "code": "86807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 463.0, "discounted_cash": 143.0, "minimum": 138.9, "maximum": 463.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 326.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 369.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 253.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 463.0 } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "857", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11591.0, "minimum": 11591.15, "maximum": 25246.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25246.1 } ] } ] }, { "description": "Brucella Antibody", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.0, "discounted_cash": 30.0, "minimum": 29.4, "maximum": 88.886, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.24 } ] } ] }, { "description": "RHIG - J2790 - 3001009", "code_information": [ { "code": "J2790", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.25, "minimum": 123.075, "maximum": 410.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 410.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 376.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 301.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.8 } ] } ] }, { "description": "Levetiracetam (Keppra) Level", "code_information": [ { "code": "80177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.5, "discounted_cash": 65.0, "minimum": 63.75, "maximum": 192.7375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.23, "10th_percentile": 90.23, "90th_percentile": 90.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 64.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 68.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 68.0, "count": "1 through 10" } ] } ] }, { "description": "DAT, IgG (Autmated)", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.5, "discounted_cash": 26.0, "minimum": 25.35, "maximum": 76.6415, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.68, "10th_percentile": 25.68, "90th_percentile": 66.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.68, "10th_percentile": 25.68, "90th_percentile": 25.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.68, "10th_percentile": 25.68, "90th_percentile": 25.68, "count": "1 through 10" } ] } ] }, { "description": "Lithium", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.5, "discounted_cash": 33.0, "minimum": 31.95, "maximum": 96.5955, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.28 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 67.73, "10th_percentile": 67.73, "90th_percentile": 67.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.32, "10th_percentile": 70.32, "90th_percentile": 106.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 100.5, "10th_percentile": 100.5, "90th_percentile": 106.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.08, "10th_percentile": 32.16, "90th_percentile": 34.08, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.08, "10th_percentile": 34.08, "90th_percentile": 34.08, "count": "1 through 10" } ] } ] }, { "description": "NM Thyroid Mets Scan Whole Body", "code_information": [ { "code": "78018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1711.75, "discounted_cash": 530.0, "minimum": 513.525, "maximum": 1711.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1072.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1451.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1451.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1711.75 } ] } ] }, { "description": "NM First Pass Multi", "code_information": [ { "code": "78483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.5, "discounted_cash": 104.0, "minimum": 100.65, "maximum": 335.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.5 } ] } ] }, { "description": "XR Foot Left 3 Views", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.5, "discounted_cash": 121.0, "minimum": 86.08, "maximum": 355.9975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 246.22, "10th_percentile": 246.22, "90th_percentile": 246.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 176.63, "10th_percentile": 166.61, "90th_percentile": 176.63, "count": "20" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.85, "10th_percentile": 120.85, "90th_percentile": 128.11, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 235.48, "10th_percentile": 235.48, "90th_percentile": 321.46, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 296.35, "10th_percentile": 296.35, "90th_percentile": 296.35, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 220.03, "10th_percentile": 118.48, "90th_percentile": 370.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 301.05, "10th_percentile": 301.05, "90th_percentile": 301.05, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 392.5, "10th_percentile": 370.25, "90th_percentile": 392.5, "count": "70" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 125.6, "10th_percentile": 118.48, "90th_percentile": 125.6, "count": "40" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 356.0, "10th_percentile": 118.48, "90th_percentile": 356.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 125.6, "10th_percentile": 118.48, "90th_percentile": 281.09, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 125.6, "10th_percentile": 118.48, "90th_percentile": 125.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.48, "10th_percentile": 118.48, "90th_percentile": 125.6, "count": "1 through 10" } ] } ] }, { "description": "EVAC SUBUNGUAL HEMAT FAC", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.0, "discounted_cash": 50.0, "minimum": 49.2, "maximum": 148.748, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.8, "10th_percentile": 73.8, "90th_percentile": 73.8, "count": "1 through 10" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 18481.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18481.58 } ] } ] }, { "description": "pH Arterial", "code_information": [ { "code": "82800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.75, "discounted_cash": 30.0, "minimum": 29.925, "maximum": 99.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 54.2 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 73.84, "10th_percentile": 73.84, "90th_percentile": 73.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 92.25, "10th_percentile": 92.25, "90th_percentile": 92.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 29.52, "10th_percentile": 29.52, "90th_percentile": 29.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 29.52, "10th_percentile": 29.52, "90th_percentile": 29.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 29.52, "10th_percentile": 29.52, "90th_percentile": 29.52, "count": "1 through 10" } ] } ] }, { "description": "BD DXA Bone Density Axial", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 662.25, "discounted_cash": 205.0, "minimum": 198.675, "maximum": 600.6608, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 483.56, "10th_percentile": 483.56, "90th_percentile": 507.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 298.01, "10th_percentile": 281.14, "90th_percentile": 298.01, "count": "32" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 337.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 203.92, "10th_percentile": 203.92, "90th_percentile": 216.16, "count": "24" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 337.77 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 421.19, "10th_percentile": 397.34, "90th_percentile": 421.19, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 520.06, "10th_percentile": 520.06, "90th_percentile": 520.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 337.52, "count": "26" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 624.75, "10th_percentile": 624.75, "90th_percentile": 662.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 211.92, "count": "96" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 572.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 211.92, "count": "53" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 199.92, "10th_percentile": 199.92, "90th_percentile": 211.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 211.92, "count": "1 through 10" } ] } ] }, { "description": "Chemo IV Infusion 0 - 1 Hr", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1159.25, "discounted_cash": 359.0, "minimum": 347.775, "maximum": 1051.4398, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 496.8, "10th_percentile": 496.8, "90th_percentile": 521.66, "count": "31" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 767.89, "10th_percentile": 614.29, "90th_percentile": 767.89, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 378.38, "10th_percentile": 360.35, "90th_percentile": 378.38, "count": "12" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 927.4, "10th_percentile": 927.4, "90th_percentile": 927.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 880.77, "10th_percentile": 880.77, "90th_percentile": 880.77, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1159.25, "10th_percentile": 1104.0, "90th_percentile": 1159.25, "count": "20" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1104.0, "10th_percentile": 1104.0, "90th_percentile": 1159.25, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 370.96, "10th_percentile": 353.28, "90th_percentile": 370.96, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1011.26, "10th_percentile": 353.28, "90th_percentile": 1051.44, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 370.96, "10th_percentile": 353.28, "90th_percentile": 370.96, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 353.28, "10th_percentile": 353.28, "90th_percentile": 370.96, "count": "21" } ] } ] }, { "description": "donotorder_ST GI Pan PCR", "code_information": [ { "code": "87507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.25, "discounted_cash": 220.0, "minimum": 213.375, "maximum": 711.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 711.25 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "989", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 14137.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14137.34 } ] } ] }, { "description": "Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281040058", "type": "NDC" }, { "code": "90715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 258.72, "10th_percentile": 258.72, "90th_percentile": 272.69, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 158.54, "10th_percentile": 134.78, "90th_percentile": 158.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 114.99, "10th_percentile": 97.76, "90th_percentile": 114.99, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 273.76, "10th_percentile": 273.76, "90th_percentile": 281.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 276.67, "10th_percentile": 276.67, "90th_percentile": 281.99, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 189.85, "10th_percentile": 189.85, "90th_percentile": 189.85, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 299.5, "10th_percentile": 0.01, "90th_percentile": 352.31, "count": "138" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.74, "10th_percentile": 106.96, "90th_percentile": 112.74, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 319.54, "10th_percentile": 319.54, "90th_percentile": 319.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 106.96, "10th_percentile": 106.96, "90th_percentile": 145.87, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 106.96, "10th_percentile": 106.96, "90th_percentile": 112.74, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.74, "10th_percentile": 95.84, "90th_percentile": 112.74, "count": "1 through 10" } ] } ] }, { "description": "Haloperidol Level", "code_information": [ { "code": "80173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.75, "discounted_cash": 149.0, "minimum": 93.15, "maximum": 436.9472, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.09 } ] } ] }, { "description": "Bone Iso", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.5, "discounted_cash": 77.0, "minimum": 74.55, "maximum": 225.3895, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 248.5, "10th_percentile": 248.5, "90th_percentile": 248.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.52, "10th_percentile": 79.52, "90th_percentile": 79.52, "count": "1 through 10" } ] } ] }, { "description": "Vasopneumatic Devices OT", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.25, "discounted_cash": 34.0, "minimum": 33.375, "maximum": 100.9038, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Uric Acid Level, Cold Method", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.5, "discounted_cash": 19.0, "minimum": 19.35, "maximum": 58.5015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 59.63, "10th_percentile": 59.63, "90th_percentile": 84.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.99, "10th_percentile": 34.99, "90th_percentile": 34.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.38, "10th_percentile": 25.38, "90th_percentile": 25.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 49.45, "10th_percentile": 49.45, "90th_percentile": 49.45, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 62.23, "10th_percentile": 61.06, "90th_percentile": 62.23, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 77.75, "10th_percentile": 3.12, "90th_percentile": 77.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 70.52, "10th_percentile": 70.52, "90th_percentile": 71.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "1 through 10" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11591.0, "minimum": 11591.15, "maximum": 26086.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26086.65 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 9444.64, "maximum": 24589.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24589.45 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3434.0, "minimum": 3434.42, "maximum": 28780.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28780.44 } ] } ] }, { "description": "Hematocrit", "code_information": [ { "code": "85014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.0, "discounted_cash": 10.0, "minimum": 10.5, "maximum": 31.745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.85, "10th_percentile": 14.85, "90th_percentile": 29.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.42, "10th_percentile": 10.77, "90th_percentile": 11.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 35.0, "10th_percentile": 33.0, "90th_percentile": 105.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.2, "10th_percentile": 10.56, "90th_percentile": 11.2, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 30.23, "10th_percentile": 30.23, "90th_percentile": 30.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.2, "10th_percentile": 10.56, "90th_percentile": 11.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.2, "10th_percentile": 11.2, "90th_percentile": 11.2, "count": "1 through 10" } ] } ] }, { "description": "Histoplasma Ab by ID", "code_information": [ { "code": "86698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.0, "discounted_cash": 33.0, "minimum": 32.7, "maximum": 109.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.0 } ] } ] }, { "description": "XR Arthrogram Ankle", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 872.5, "discounted_cash": 270.0, "minimum": 261.75, "maximum": 854.4888, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 285.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 387.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 387.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 854.49 } ] } ] }, { "description": "OT Re-Eval Est Plan Care", "code_information": [ { "code": "97168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.25, "discounted_cash": 87.0, "minimum": 84.975, "maximum": 256.9078, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "MA Mammo Bilat Screen w CAD Digital", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.0, "discounted_cash": 165.0, "minimum": 160.2, "maximum": 534.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 355.11, "10th_percentile": 355.11, "90th_percentile": 355.11, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 240.3, "10th_percentile": 240.3, "90th_percentile": 240.3, "count": "84" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 534.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 174.3, "10th_percentile": 174.3, "90th_percentile": 174.3, "count": "82" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 534.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 339.62, "10th_percentile": 339.62, "90th_percentile": 339.62, "count": "41" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 419.35, "10th_percentile": 419.35, "90th_percentile": 427.41, "count": "53" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 322.72, "10th_percentile": 322.72, "90th_percentile": 322.72, "count": "62" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 355.11, "10th_percentile": 355.11, "90th_percentile": 413.32, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 83.56, "10th_percentile": 82.9, "90th_percentile": 85.16, "count": "124" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.56, "10th_percentile": 90.56, "90th_percentile": 90.56, "count": "255" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 534.0, "10th_percentile": 534.0, "90th_percentile": 534.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 125.16, "10th_percentile": 125.16, "90th_percentile": 125.16, "count": "153" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.88, "10th_percentile": 170.88, "90th_percentile": 170.88, "count": "16" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.88, "10th_percentile": 170.88, "90th_percentile": 170.88, "count": "27" } ] } ] }, { "description": "Aph RBC ACDA AS1 LR", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 794.75, "minimum": 238.425, "maximum": 720.8383, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 715.28, "10th_percentile": 357.64, "90th_percentile": 715.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 518.81, "10th_percentile": 259.41, "90th_percentile": 518.81, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 794.75, "10th_percentile": 794.75, "90th_percentile": 794.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 508.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 727.99, "10th_percentile": 727.99, "90th_percentile": 727.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 508.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 508.64, "10th_percentile": 508.64, "90th_percentile": 508.64, "count": "1 through 10" } ] } ] }, { "description": "NM Thyroid Uptake Only", "code_information": [ { "code": "78012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 154.0, "minimum": 149.25, "maximum": 497.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 316.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 428.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 428.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 497.5 } ] } ] }, { "description": "ADH (Copeptin)", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 540.75, "discounted_cash": 167.0, "minimum": 162.225, "maximum": 490.4602, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 217.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.38 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "818", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 13665.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13665.79 } ] } ] }, { "description": "96374 - ED IV Push INITL or Single", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.5, "discounted_cash": 157.0, "minimum": 151.95, "maximum": 459.3955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 336.82, "10th_percentile": 336.82, "90th_percentile": 673.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 227.93, "10th_percentile": 227.93, "90th_percentile": 227.93, "count": "47" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 165.32, "10th_percentile": 165.32, "90th_percentile": 335.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 165.32, "10th_percentile": 165.32, "90th_percentile": 165.32, "count": "46" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 397.75, "10th_percentile": 397.75, "90th_percentile": 405.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 463.95, "10th_percentile": 459.39, "90th_percentile": 2433.49, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 250.14, "10th_percentile": 161.2, "90th_percentile": 506.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 388.49, "10th_percentile": 172.22, "90th_percentile": 392.03, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 506.5, "10th_percentile": 506.5, "90th_percentile": 506.5, "count": "311" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 162.08, "10th_percentile": 162.08, "90th_percentile": 162.08, "count": "113" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 283.05, "10th_percentile": 283.05, "90th_percentile": 459.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 162.08, "10th_percentile": 162.08, "90th_percentile": 162.08, "count": "97" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 162.08, "10th_percentile": 162.08, "90th_percentile": 162.08, "count": "59" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 162.08, "10th_percentile": 162.08, "90th_percentile": 162.08, "count": "15" } ] } ] }, { "description": "Morphine Sulfate IV Soln PF 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323045201", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.03, "10th_percentile": 6.03, "90th_percentile": 6.03, "count": "1 through 10" } ] } ] }, { "description": "Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 881.5, "discounted_cash": 273.0, "minimum": 95.3, "maximum": 799.5205, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 138.89 } ] } ] }, { "description": "SLP Assessment of Aphasia Units", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 414.0, "discounted_cash": 128.0, "minimum": 95.0, "maximum": 375.498, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Self Care ADL Training/15 min Lymphedema", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.75, "discounted_cash": 40.0, "minimum": 39.225, "maximum": 118.5902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.1, "10th_percentile": 53.1, "90th_percentile": 58.84, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 66.06, "10th_percentile": 66.06, "90th_percentile": 66.06, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.68, "10th_percentile": 41.84, "90th_percentile": 167.36, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.84, "10th_percentile": 41.84, "90th_percentile": 41.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.84, "10th_percentile": 41.84, "90th_percentile": 83.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.84, "10th_percentile": 41.84, "90th_percentile": 41.84, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 11291.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11291.49 } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [ { "code": "180", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 20819.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20819.34 } ] } ] }, { "description": "HLA B27", "code_information": [ { "code": "86812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.75, "discounted_cash": 84.0, "minimum": 81.825, "maximum": 247.3843, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 213.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 241.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.97, "10th_percentile": 83.97, "90th_percentile": 83.97, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 165.09 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 163.61, "10th_percentile": 163.61, "90th_percentile": 163.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 257.25, "10th_percentile": 257.25, "90th_percentile": 272.75, "count": "1 through 10" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "743", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 14626.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14626.59 } ] } ] }, { "description": "96377 APPLICATION ON-BODY INJECTOR", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.5, "discounted_cash": 50.0, "minimum": 48.45, "maximum": 146.4805, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 51.68, "10th_percentile": 51.68, "90th_percentile": 51.68, "count": "1 through 10" } ] } ] }, { "description": "IsoPSA", "code_information": [ { "code": "0359U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 812.5, "minimum": 243.75, "maximum": 812.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 812.5 } ] } ] }, { "description": "US Obstetrical Complete 14+ Wk", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 897.5, "discounted_cash": 278.0, "minimum": 269.25, "maximum": 814.0325, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 525.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 752.93 } ] } ] }, { "description": "Histamine, Urine", "code_information": [ { "code": "83088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.5, "discounted_cash": 31.0, "minimum": 30.45, "maximum": 101.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 101.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.5 } ] } ] }, { "description": "CBC", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.5, "discounted_cash": 25.0, "minimum": 24.75, "maximum": 74.8275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 51.7, "10th_percentile": 51.7, "90th_percentile": 51.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.99, "10th_percentile": 34.99, "90th_percentile": 37.13, "count": "80" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.38, "10th_percentile": 25.38, "90th_percentile": 26.93, "count": "39" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.41 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 31.88, "10th_percentile": 31.88, "90th_percentile": 77.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 4.64, "90th_percentile": 82.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 63.28, "10th_percentile": 51.7, "90th_percentile": 63.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 82.5, "10th_percentile": 77.75, "90th_percentile": 82.5, "count": "222" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.4, "count": "185" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 62.03, "10th_percentile": 26.4, "90th_percentile": 74.83, "count": "46" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.4, "count": "111" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.4, "count": "23" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.4, "count": "1 through 10" } ] } ] }, { "description": "OTHER HEART ASSIST SYSTEM IMPLANT", "code_information": [ { "code": "215", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 117382.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 117382.87 } ] } ] }, { "description": "US Preg Uterus Ea Addl Gestation", "code_information": [ { "code": "76812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.0, "discounted_cash": 193.0, "minimum": 187.2, "maximum": 624.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.0 } ] } ] }, { "description": "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES", "code_information": [ { "code": "004", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48081.0, "minimum": 48081.82, "maximum": 163293.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 163293.88 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH CC", "code_information": [ { "code": "501", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 20608.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20608.32 } ] } ] }, { "description": "Islet Cell Antibody, IgG", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.0, "discounted_cash": 48.0, "minimum": 46.5, "maximum": 155.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 155.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 155.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 126.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 146.25, "10th_percentile": 146.25, "90th_percentile": 146.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.8, "10th_percentile": 46.8, "90th_percentile": 46.8, "count": "1 through 10" } ] } ] }, { "description": "RPR", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.25, "discounted_cash": 27.0, "minimum": 26.775, "maximum": 80.9497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 65.21, "10th_percentile": 65.21, "90th_percentile": 65.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.91, "10th_percentile": 37.91, "90th_percentile": 37.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 56.76, "10th_percentile": 56.76, "90th_percentile": 56.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 4.27, "10th_percentile": 4.27, "90th_percentile": 4.27, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 77.17, "10th_percentile": 26.96, "90th_percentile": 80.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 26.96, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITHOUT CCMCC", "code_information": [ { "code": "182", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 8886.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8886.53 } ] } ] }, { "description": "Prolactin Level", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.25, "discounted_cash": 60.0, "minimum": 58.275, "maximum": 181.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 150.35, "10th_percentile": 150.35, "90th_percentile": 150.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 124.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 123.54, "10th_percentile": 123.54, "90th_percentile": 123.54, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 152.54, "10th_percentile": 152.54, "90th_percentile": 155.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 194.25, "10th_percentile": 194.25, "90th_percentile": 194.25, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 62.16, "10th_percentile": 62.16, "90th_percentile": 62.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 176.18, "10th_percentile": 176.18, "90th_percentile": 176.19, "count": "1 through 10" } ] } ] }, { "description": "$ AP 88323 Consult", "code_information": [ { "code": "88323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.5, "discounted_cash": 365.0, "minimum": 342.5688, "maximum": 1069.8065, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.57 } ] } ] }, { "description": "ANCA, IgG", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 63.0, "minimum": 60.975, "maximum": 184.3477, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 153.48, "10th_percentile": 153.48, "90th_percentile": 153.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 395.75, "10th_percentile": 191.75, "90th_percentile": 687.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.04, "10th_percentile": 18.64, "90th_percentile": 281.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 184.35, "10th_percentile": 184.35, "90th_percentile": 184.35, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.04, "10th_percentile": 61.36, "90th_percentile": 65.04, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 91.46, "10th_percentile": 91.46, "90th_percentile": 172.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.59 } ] } ] }, { "description": "NM Cardiac Amyloid SPECT NC 78803", "code_information": [ { "code": "78803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4947.75, "discounted_cash": 1533.0, "minimum": 1184.59, "maximum": 4487.6093, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1184.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1603.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1603.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2521.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 368.8, "10th_percentile": 368.8, "90th_percentile": 368.8, "count": "1 through 10" } ] } ] }, { "description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [ { "code": "642", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 16765.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16765.11 } ] } ] }, { "description": "MRI Abdomen w+wo Contrast", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2887.25, "discounted_cash": 895.0, "minimum": 866.175, "maximum": 2887.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1299.26, "10th_percentile": 1299.26, "90th_percentile": 1299.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2887.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2887.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 2267.36, "10th_percentile": 2267.36, "90th_percentile": 2267.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2072.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 983.92, "10th_percentile": 983.92, "90th_percentile": 983.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2887.25, "10th_percentile": 2887.25, "90th_percentile": 2887.25, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 923.92, "10th_percentile": 895.05, "90th_percentile": 923.92, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2303.45, "10th_percentile": 2303.45, "90th_percentile": 2618.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 923.92, "10th_percentile": 923.92, "90th_percentile": 923.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 923.92, "10th_percentile": 923.92, "90th_percentile": 923.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 923.92, "10th_percentile": 923.92, "90th_percentile": 923.92, "count": "1 through 10" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [ { "code": "141", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 25712.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25712.94 } ] } ] }, { "description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CCMCC", "code_information": [ { "code": "746", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 20478.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20478.64 } ] } ] }, { "description": "PFT Full", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 461.5, "discounted_cash": 143.0, "minimum": 138.45, "maximum": 418.5805, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 330.5, "10th_percentile": 330.5, "90th_percentile": 353.97, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 207.68, "10th_percentile": 192.15, "90th_percentile": 207.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 305.7, "10th_percentile": 232.2, "90th_percentile": 305.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 150.63, "10th_percentile": 139.37, "90th_percentile": 150.63, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 349.71, "10th_percentile": 349.71, "90th_percentile": 349.71, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 341.77, "10th_percentile": 341.77, "90th_percentile": 341.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 368.18, "10th_percentile": 368.18, "90th_percentile": 368.18, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 158.74, "10th_percentile": 158.74, "90th_percentile": 158.74, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 353.97, "10th_percentile": 353.97, "90th_percentile": 353.97, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 461.5, "10th_percentile": 427.0, "90th_percentile": 461.5, "count": "19" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 147.68, "10th_percentile": 136.64, "90th_percentile": 147.68, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 418.58, "10th_percentile": 418.58, "90th_percentile": 418.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.13, "10th_percentile": 27.33, "90th_percentile": 147.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.64, "10th_percentile": 136.64, "90th_percentile": 147.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.64, "10th_percentile": 136.64, "90th_percentile": 147.68, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17601.0, "minimum": 17601.38, "maximum": 90519.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 90519.33 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "087", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 10783.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10783.38 } ] } ] }, { "description": "C3 (Complement C3)", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.75, "discounted_cash": 40.0, "minimum": 39.225, "maximum": 118.5902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 200.57, "10th_percentile": 200.57, "90th_percentile": 200.57, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 92.7, "10th_percentile": 92.7, "90th_percentile": 92.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 85.35, "10th_percentile": 85.35, "90th_percentile": 85.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.33 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 102.68, "10th_percentile": 102.68, "90th_percentile": 102.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 130.75, "10th_percentile": 123.25, "90th_percentile": 261.5, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.84, "10th_percentile": 39.44, "90th_percentile": 83.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.84, "10th_percentile": 39.44, "90th_percentile": 41.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.84, "10th_percentile": 41.84, "90th_percentile": 41.84, "count": "1 through 10" } ] } ] }, { "description": "SHBG (Sex Hormone Binding Globulin)", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.5, "discounted_cash": 34.0, "minimum": 33.15, "maximum": 110.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 73.48, "10th_percentile": 73.48, "90th_percentile": 73.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.73, "10th_percentile": 49.73, "90th_percentile": 49.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.07, "10th_percentile": 36.07, "90th_percentile": 36.07, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 70.28, "10th_percentile": 70.28, "90th_percentile": 70.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 88.44, "10th_percentile": 86.78, "90th_percentile": 88.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 110.5, "10th_percentile": 110.5, "90th_percentile": 110.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 110.5, "10th_percentile": 110.5, "90th_percentile": 110.5, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 35.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 100.22, "10th_percentile": 35.36, "90th_percentile": 101.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 35.36, "count": "1 through 10" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51516.0, "minimum": 51516.24, "maximum": 251700.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 251700.62 } ] } ] }, { "description": "Echo 2-D Limited F/U w/Contrast - 93308 - 5001003", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1496.75, "discounted_cash": 463.0, "minimum": 449.025, "maximum": 1357.5522, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 991.45, "10th_percentile": 991.45, "90th_percentile": 991.45, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 283.24, "10th_percentile": 283.24, "90th_percentile": 283.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1496.75, "10th_percentile": 1496.75, "90th_percentile": 1496.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 478.96, "10th_percentile": 391.52, "90th_percentile": 478.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.0, "10th_percentile": 170.0, "90th_percentile": 170.0, "count": "1 through 10" } ] } ] }, { "description": "XR Facial Bones 3-4 Views", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 456.25, "discounted_cash": 141.0, "minimum": 118.15, "maximum": 413.8188, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 159.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 159.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.08 } ] } ] }, { "description": "Iontophoresis/15 min OT", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 31.0, "minimum": 30.9, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CPR FAC", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1171.5, "discounted_cash": 363.0, "minimum": 351.45, "maximum": 1062.5505, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 357.04, "10th_percentile": 357.04, "90th_percentile": 357.04, "count": "1 through 10" } ] } ] }, { "description": "MRI Neck wo Contrast", "code_information": [ { "code": "70540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1604.75, "discounted_cash": 497.0, "minimum": 481.425, "maximum": 1604.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1604.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1604.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1435.44 } ] } ] }, { "description": "NORMAL NEWBORN", "code_information": [ { "code": "795", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 2355.44, "maximum": 6953.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2355.44 } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [ { "code": "164", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 29755.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29755.39 } ] } ] }, { "description": "IR Trnscath Biopsy S+I", "code_information": [ { "code": "75970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2804.5, "discounted_cash": 869.0, "minimum": 841.35, "maximum": 2804.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1754.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2376.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2376.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2804.5 } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj 125 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00143975401", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 42.86, "10th_percentile": 42.86, "90th_percentile": 42.86, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 52.1, "10th_percentile": 52.1, "90th_percentile": 52.1, "count": "1 through 10" } ] } ] }, { "description": "Factor VII, Activity", "code_information": [ { "code": "85230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.75, "discounted_cash": 82.0, "minimum": 80.025, "maximum": 241.9423, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.86 } ] } ] }, { "description": "Semen Analysis, Post Procedure", "code_information": [ { "code": "89310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.0, "discounted_cash": 39.0, "minimum": 37.8, "maximum": 114.282, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.26 } ] } ] }, { "description": "88162 AP Bill Non-Gyn Cytology 5+ Slides", "code_information": [ { "code": "88162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.75, "discounted_cash": 60.0, "minimum": 58.725, "maximum": 195.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.75 } ] } ] }, { "description": "Hydromorphone HCl Inj 1 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323085225", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 23.73, "10th_percentile": 23.73, "90th_percentile": 23.73, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 14.5, "10th_percentile": 13.81, "90th_percentile": 14.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "1 through 10" } ] } ] }, { "description": "DRAIN/INJ JOINT/BURSA W US FAC", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.25, "discounted_cash": 81.0, "minimum": 78.975, "maximum": 238.7678, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.61, "10th_percentile": 81.61, "90th_percentile": 81.61, "count": "1 through 10" } ] } ] }, { "description": "RENAL FAILURE WITH MCC", "code_information": [ { "code": "682", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 7298.7124, "maximum": 17459.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17459.48 } ] } ] }, { "description": "CT CCTA w+wo Disease Strxr", "code_information": [ { "code": "75573", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1451.25, "discounted_cash": 449.0, "minimum": 435.375, "maximum": 1451.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1378.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1378.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1451.25 } ] } ] }, { "description": "PT Apply Multilay Comprs Lwr Leg Unit", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 482.0, "discounted_cash": 149.0, "minimum": 95.0, "maximum": 437.174, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "IR Hepatic Portogram w Press 75887", "code_information": [ { "code": "75887", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3164.5, "discounted_cash": 980.0, "minimum": 617.6279, "maximum": 2870.2015, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 854.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1157.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1157.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.63 } ] } ] }, { "description": "MRI Thoracic Spine wo Contrast", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2090.25, "discounted_cash": 647.0, "minimum": 627.075, "maximum": 1906.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1603.22, "10th_percentile": 1603.22, "90th_percentile": 1603.22, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1068.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2090.25, "10th_percentile": 2090.25, "90th_percentile": 2090.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 13913.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13913.35 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC", "code_information": [ { "code": "686", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 21263.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21263.78 } ] } ] }, { "description": "XR Lumbar Spine AP+Lateral", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 564.5, "discounted_cash": 174.0, "minimum": 109.41, "maximum": 512.0015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 354.11, "10th_percentile": 354.11, "90th_percentile": 354.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 254.03, "10th_percentile": 239.63, "90th_percentile": 254.03, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 173.81, "10th_percentile": 173.81, "90th_percentile": 184.25, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 148.15 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 99.32, "10th_percentile": 99.32, "90th_percentile": 99.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 443.3, "10th_percentile": 426.21, "90th_percentile": 443.3, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.4, "10th_percentile": 48.77, "90th_percentile": 532.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 532.5, "10th_percentile": 532.5, "90th_percentile": 564.5, "count": "35" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.4, "10th_percentile": 170.4, "90th_percentile": 180.64, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 170.4, "10th_percentile": 34.08, "90th_percentile": 512.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.4, "10th_percentile": 34.08, "90th_percentile": 276.73, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 180.64, "10th_percentile": 180.64, "90th_percentile": 180.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.4, "10th_percentile": 170.4, "90th_percentile": 180.64, "count": "1 through 10" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7512.0, "minimum": 7512.79, "maximum": 14259.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14259.95 } ] } ] }, { "description": "74160 FAC CT ABDOMEN W CONTRAST", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2757.25, "discounted_cash": 854.0, "minimum": 650.0, "maximum": 2500.8257, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1047.38, "10th_percentile": 1047.38, "90th_percentile": 1110.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1633.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 759.7, "10th_percentile": 759.7, "90th_percentile": 805.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1633.62 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1519.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2467.25, "10th_percentile": 2327.5, "90th_percentile": 2467.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 789.52, "10th_percentile": 789.52, "90th_percentile": 789.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 744.8, "10th_percentile": 744.8, "90th_percentile": 789.52, "count": "1 through 10" } ] } ] }, { "description": "MOUTH PROCEDURES WITH CCMCC", "code_information": [ { "code": "137", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 17603.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17603.3 } ] } ] }, { "description": "XR Ribs Left w PA Chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.0, "discounted_cash": 191.0, "minimum": 103.59, "maximum": 561.433, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 474.77, "10th_percentile": 474.77, "90th_percentile": 474.77, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 278.55, "10th_percentile": 262.8, "90th_percentile": 278.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 190.62, "10th_percentile": 190.62, "90th_percentile": 190.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.27 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 467.43, "10th_percentile": 467.43, "90th_percentile": 467.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 289.61, "10th_percentile": 289.61, "90th_percentile": 289.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 619.0, "10th_percentile": 584.0, "90th_percentile": 619.0, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 186.88, "10th_percentile": 186.88, "90th_percentile": 198.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 561.44, "10th_percentile": 561.44, "90th_percentile": 561.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 198.08, "10th_percentile": 186.88, "90th_percentile": 347.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 186.88, "10th_percentile": 186.88, "90th_percentile": 198.08, "count": "1 through 10" } ] } ] }, { "description": "SLP Group Therapy Units", "code_information": [ { "code": "92508", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.5, "discounted_cash": 85.0, "minimum": 82.35, "maximum": 248.9715, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 51015.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51015.63 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "544", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 10159.1256, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8895.96 } ] } ] }, { "description": "HEADACHES WITHOUT MCC", "code_information": [ { "code": "103", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 9859.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9859.12 } ] } ] }, { "description": "Bill IRL Dif Aut Adsorp Ea", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.0, "discounted_cash": 35.0, "minimum": 34.8, "maximum": 116.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 } ] } ] }, { "description": "%CDIFF Reflex Toxin", "code_information": [ { "code": "87803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.0, "discounted_cash": 22.0, "minimum": 22.2, "maximum": 74.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 69.75, "10th_percentile": 69.75, "90th_percentile": 69.75, "count": "1 through 10" } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "099", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 16061.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16061.31 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10517.0, "minimum": 10517.9, "maximum": 28943.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28943.12 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 17843.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17843.8 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [ { "code": "840", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14596.0, "minimum": 14596.27, "maximum": 38136.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38136.17 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 38810.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38810.5 } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC", "code_information": [ { "code": "803", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 21914.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21914.53 } ] } ] }, { "description": "CYSTGRAPH TUBE SIMPLE FAC", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 977.5, "discounted_cash": 303.0, "minimum": 293.25, "maximum": 886.5925, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 297.92, "10th_percentile": 297.92, "90th_percentile": 297.92, "count": "1 through 10" } ] } ] }, { "description": "XR Knee Left 4 Views", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504.75, "discounted_cash": 156.0, "minimum": 112.33, "maximum": 457.8082, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 316.71, "10th_percentile": 316.71, "90th_percentile": 316.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 227.14, "10th_percentile": 214.31, "90th_percentile": 227.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 164.75, "10th_percentile": 155.45, "90th_percentile": 164.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 152.1 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 321.02, "10th_percentile": 321.02, "90th_percentile": 321.02, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 381.19, "10th_percentile": 381.19, "90th_percentile": 396.38, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 201.18, "10th_percentile": 161.52, "90th_percentile": 246.89, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 504.75, "10th_percentile": 476.25, "90th_percentile": 504.75, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 161.52, "10th_percentile": 152.4, "90th_percentile": 161.52, "count": "44" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 152.4, "10th_percentile": 25.0, "90th_percentile": 457.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 161.52, "10th_percentile": 152.4, "90th_percentile": 243.36, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 161.52, "10th_percentile": 161.52, "90th_percentile": 161.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 161.52, "10th_percentile": 152.4, "90th_percentile": 161.52, "count": "1 through 10" } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [ { "code": "669", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 18296.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18296.5 } ] } ] }, { "description": "MRI Brain w+wo Contrast", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2514.75, "discounted_cash": 779.0, "minimum": 754.425, "maximum": 2514.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1928.81, "10th_percentile": 1928.81, "90th_percentile": 1928.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1131.64, "10th_percentile": 1131.64, "90th_percentile": 1131.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2514.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 820.81, "10th_percentile": 820.81, "90th_percentile": 820.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2514.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1974.83, "10th_percentile": 1974.83, "90th_percentile": 1974.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1864.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 864.72, "10th_percentile": 864.72, "90th_percentile": 864.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2514.75, "10th_percentile": 2514.75, "90th_percentile": 2514.75, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 804.72, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2280.88, "10th_percentile": 2280.88, "90th_percentile": 2303.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 804.72, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 804.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 804.72, "count": "1 through 10" } ] } ] }, { "description": "XR Ribs Bilateral w PA Chest", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 662.25, "discounted_cash": 205.0, "minimum": 144.44, "maximum": 600.6608, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 144.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 195.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 662.25, "10th_percentile": 662.25, "90th_percentile": 662.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 572.27, "10th_percentile": 572.27, "90th_percentile": 572.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 199.92, "10th_percentile": 199.92, "90th_percentile": 199.92, "count": "1 through 10" } ] } ] }, { "description": "IR Adrenal Artery Scan Unilateral S+I", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1307.25, "discounted_cash": 405.0, "minimum": 392.175, "maximum": 1278.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 943.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1278.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1278.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 846.02 } ] } ] }, { "description": "RHIG - 90384 - 3001009", "code_information": [ { "code": "90384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.25, "discounted_cash": 127.0, "minimum": 123.075, "maximum": 410.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 410.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 377.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 302.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 410.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 372.1, "10th_percentile": 372.1, "90th_percentile": 372.1, "count": "1 through 10" } ] } ] }, { "description": "US Obstetrical Follow-Up", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556.0, "discounted_cash": 172.0, "minimum": 166.8, "maximum": 556.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 556.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 524.5, "10th_percentile": 524.5, "90th_percentile": 556.0, "count": "1 through 10" } ] } ] }, { "description": "MRI Abdomen w Contrast", "code_information": [ { "code": "74182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 669.0, "minimum": 647.7, "maximum": 2159.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1948.64 } ] } ] }, { "description": "MA US Elastography EA Add Lesion 76983", "code_information": [ { "code": "76983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 379.25, "discounted_cash": 117.0, "minimum": 113.775, "maximum": 343.9798, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 313.01 } ] } ] }, { "description": "MRI Angio Spine w+wo Contrast 72159", "code_information": [ { "code": "72159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1827.5, "discounted_cash": 566.0, "minimum": 548.25, "maximum": 1827.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1827.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1827.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1827.5 } ] } ] }, { "description": "Bill Chr Anal POC Culture", "code_information": [ { "code": "88233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 926.5, "discounted_cash": 287.0, "minimum": 277.95, "maximum": 926.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 725.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 821.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 562.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 926.5 } ] } ] }, { "description": "Lidocaine Level", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.25, "discounted_cash": 34.0, "minimum": 33.075, "maximum": 110.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.25 } ] } ] }, { "description": "Thyroid Peroxidase Ab (TPO)", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.75, "discounted_cash": 81.0, "minimum": 78.525, "maximum": 237.4073, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 85.44, "10th_percentile": 85.44, "90th_percentile": 85.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.11 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 197.7, "10th_percentile": 197.7, "90th_percentile": 197.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 165.88, "10th_percentile": 165.88, "90th_percentile": 165.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 261.75, "10th_percentile": 219.75, "90th_percentile": 261.75, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.04, "10th_percentile": 79.04, "90th_percentile": 83.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.76, "10th_percentile": 83.76, "90th_percentile": 83.76, "count": "1 through 10" } ] } ] }, { "description": "XR Scoliosis 1 View", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.0, "discounted_cash": 106.0, "minimum": 103.5, "maximum": 312.915, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.6 } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "329", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20177.0, "minimum": 20177.19, "maximum": 54188.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54188.05 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CCMCC", "code_information": [ { "code": "717", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 22287.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22287.07 } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "417", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 28133.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28133.22 } ] } ] }, { "description": "XR Clavicle Left", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.0, "discounted_cash": 103.0, "minimum": 75.84, "maximum": 302.938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 256.18, "10th_percentile": 256.18, "90th_percentile": 256.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.69 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 257.99, "10th_percentile": 257.98, "90th_percentile": 273.55, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 252.13, "10th_percentile": 252.13, "90th_percentile": 252.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 334.0, "10th_percentile": 315.0, "90th_percentile": 334.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 288.54, "10th_percentile": 288.54, "90th_percentile": 302.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 100.8, "10th_percentile": 100.8, "90th_percentile": 100.8, "count": "1 through 10" } ] } ] }, { "description": "Glucose, Test Strip POC", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.25, "discounted_cash": 4.0, "minimum": 4.575, "maximum": 15.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.25 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 23132.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23132.34 } ] } ] }, { "description": "Lead, Blood", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.75, "discounted_cash": 37.0, "minimum": 36.225, "maximum": 113.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 80.3, "10th_percentile": 80.3, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.42 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 76.8, "10th_percentile": 76.8, "90th_percentile": 76.8, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 94.83, "10th_percentile": 94.83, "90th_percentile": 96.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "66" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 109.52, "10th_percentile": 96.14, "90th_percentile": 110.61, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 33.92, "10th_percentile": 33.92, "90th_percentile": 33.92, "count": "1 through 10" } ] } ] }, { "description": "Coagulation Workup Mixing Studies", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.25, "discounted_cash": 88.0, "minimum": 75.8, "maximum": 258.7217, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 91.28, "10th_percentile": 91.28, "90th_percentile": 91.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.08, "10th_percentile": 86.08, "90th_percentile": 86.08, "count": "1 through 10" } ] } ] }, { "description": "$ RBC, leuko reduced, irr, ea unit", "code_information": [ { "code": "P9040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 794.75, "minimum": 238.425, "maximum": 720.8383, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 634.05, "10th_percentile": 634.05, "90th_percentile": 1268.1, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 254.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 508.64, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 508.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 357.64, "10th_percentile": 357.64, "90th_percentile": 357.64, "count": "1 through 10" } ] } ] }, { "description": "PT Canalith Repositioning Units", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.75, "discounted_cash": 42.0, "minimum": 41.025, "maximum": 124.0323, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "XR Lumbar Sp w Bending Min 6V", "code_information": [ { "code": "72114", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.25, "discounted_cash": 244.0, "minimum": 207.14, "maximum": 714.0358, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 207.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 280.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 280.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.64 } ] } ] }, { "description": "Protein C, Functional", "code_information": [ { "code": "85303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.0, "discounted_cash": 83.0, "minimum": 80.7, "maximum": 243.983, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.08, "10th_percentile": 86.08, "90th_percentile": 86.08, "count": "1 through 10" } ] } ] }, { "description": "DNase B Antibody", "code_information": [ { "code": "86215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 52.0, "minimum": 50.4, "maximum": 152.376, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.51 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [ { "code": "957", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21679.0, "minimum": 21679.75, "maximum": 89830.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 89830.85 } ] } ] }, { "description": "Organic Acids, Urine", "code_information": [ { "code": "83918", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.25, "discounted_cash": 138.0, "minimum": 105.33, "maximum": 403.8417, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.99 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC", "code_information": [ { "code": "495", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15454.0, "minimum": 15454.87, "maximum": 42743.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42743.3 } ] } ] }, { "description": "$ Electrolytes 80051", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 29.0, "minimum": 28.35, "maximum": 85.7115, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" } ] } ] }, { "description": "Ketorolac Tromethamine IM Inj 60 MG/2ML (30 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "65145014701", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 11.86, "10th_percentile": 11.86, "90th_percentile": 11.86, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 13.81, "10th_percentile": 13.81, "90th_percentile": 14.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 10.57, "10th_percentile": 10.57, "90th_percentile": 17.14, "count": "1 through 10" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 30579.3633, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8523.78, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 47583.51, "10th_percentile": 47583.51, "90th_percentile": 47583.51, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8156.74, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 14920.85, "10th_percentile": 14920.85, "90th_percentile": 14920.85, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8156.74, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 16642.33, "10th_percentile": 16642.33, "90th_percentile": 16642.33, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15273.8 } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "274", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2575.0, "minimum": 2575.81, "maximum": 38805.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38805.79 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 8922.1875, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 7869.63, "standard_charge_algorithm": "80% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8653.52, "10th_percentile": 8653.52, "90th_percentile": 8653.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 4722.32, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4583.16, "10th_percentile": 4583.16, "90th_percentile": 4583.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 4722.32, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9192.0, "10th_percentile": 9192.0, "90th_percentile": 9192.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7325.67 } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [ { "code": "901", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18030.0, "minimum": 18030.68, "maximum": 49473.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49473.63 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [ { "code": "565", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 11487.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11487.18 } ] } ] }, { "description": "Cancer Antigen 125", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.5, "discounted_cash": 72.0, "minimum": 70.35, "maximum": 212.6915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 171.25, "10th_percentile": 171.25, "90th_percentile": 171.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 194.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 234.5, "10th_percentile": 234.5, "90th_percentile": 234.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "1 through 10" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [ { "code": "031", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15025.0, "minimum": 15025.57, "maximum": 52820.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52820.52 } ] } ] }, { "description": "NM I 123 MIBG per dose up to 15mCi", "code_information": [ { "code": "A9582", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13426.75, "minimum": 4028.025, "maximum": 13426.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13426.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13426.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13426.75 } ] } ] }, { "description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [ { "code": "054", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 18000.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18000.59 } ] } ] }, { "description": "XR Urethrocystogram Retro S+I 74450", "code_information": [ { "code": "74450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1059.0, "discounted_cash": 328.0, "minimum": 234.89, "maximum": 960.513, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 434.31 } ] } ] }, { "description": "Viscosity, Serum", "code_information": [ { "code": "85810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.5, "discounted_cash": 44.0, "minimum": 43.35, "maximum": 131.0615, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.78 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "206", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 3054.7079, "maximum": 11094.61, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5151.62, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2291.58, "10th_percentile": 2291.58, "90th_percentile": 2291.58, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11094.61 } ] } ] }, { "description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC", "code_information": [ { "code": "067", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 17314.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17314.47 } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 21135.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21135.28 } ] } ] }, { "description": "IR Adrenal Vein Scan Unilateral S+I", "code_information": [ { "code": "75840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1307.25, "discounted_cash": 405.0, "minimum": 392.175, "maximum": 1185.6758, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 837.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1133.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1133.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.5 } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 16489.9508, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6953.61, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17013.98, "10th_percentile": 2380.48, "90th_percentile": 27198.58, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6654.18, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10657.75, "10th_percentile": 4583.16, "90th_percentile": 13749.48, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10267.02 } ] } ] }, { "description": "Bill IRL Hgb S Ea", "code_information": [ { "code": "85660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.0, "discounted_cash": 114.0, "minimum": 35.31, "maximum": 333.776, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.36 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 15282.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15282.05 } ] } ] }, { "description": "Beta-Hydroxybutyrate, Blood", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.75, "discounted_cash": 24.0, "minimum": 23.325, "maximum": 76.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 51.7, "10th_percentile": 51.7, "90th_percentile": 51.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.99, "10th_percentile": 34.99, "90th_percentile": 34.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.38, "10th_percentile": 25.38, "90th_percentile": 25.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.27 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 63.68, "10th_percentile": 63.68, "90th_percentile": 63.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 61.06, "10th_percentile": 61.06, "90th_percentile": 61.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.16 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 59.63, "10th_percentile": 59.63, "90th_percentile": 59.63, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "19" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "1 through 10" } ] } ] }, { "description": "MRI Forearm Left w+wo Contrast", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2724.25, "discounted_cash": 844.0, "minimum": 817.275, "maximum": 2724.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 2089.5, "10th_percentile": 2089.5, "90th_percentile": 2089.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2724.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2724.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2715.7 } ] } ] }, { "description": "COVID-19 (on-site)", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.0, "discounted_cash": 45.0, "minimum": 43.8, "maximum": 146.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.7, "10th_percentile": 65.7, "90th_percentile": 65.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 137.75, "10th_percentile": 137.75, "90th_percentile": 137.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.96, "10th_percentile": 44.96, "90th_percentile": 47.65, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 110.26, "10th_percentile": 110.26, "90th_percentile": 110.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 137.75, "10th_percentile": 137.75, "90th_percentile": 137.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.08, "10th_percentile": 44.08, "90th_percentile": 46.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 109.9, "10th_percentile": 109.9, "90th_percentile": 109.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.08, "10th_percentile": 44.08, "90th_percentile": 46.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.72, "10th_percentile": 46.72, "90th_percentile": 46.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.08, "10th_percentile": 44.08, "90th_percentile": 46.72, "count": "1 through 10" } ] } ] }, { "description": "Oxcarbazepine Metabolite", "code_information": [ { "code": "80183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 29.0, "minimum": 28.2, "maximum": 94.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" } ] } ] }, { "description": "INR", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.75, "discounted_cash": 24.0, "minimum": 23.925, "maximum": 72.3333, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 47.71, "10th_percentile": 47.71, "90th_percentile": 55.53, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.89, "10th_percentile": 32.29, "90th_percentile": 35.89, "count": "53" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.03, "10th_percentile": 23.42, "90th_percentile": 26.03, "count": "41" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.15 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 65.32, "10th_percentile": 65.32, "90th_percentile": 65.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 57.43, "10th_percentile": 57.43, "90th_percentile": 62.63, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 71.75, "10th_percentile": 3.76, "90th_percentile": 79.75, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 61.17, "10th_percentile": 47.71, "90th_percentile": 61.17, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 79.75, "10th_percentile": 71.75, "90th_percentile": 79.75, "count": "276" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 25.52, "count": "364" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 72.33, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 25.52, "count": "255" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 25.52, "count": "44" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 25.52, "count": "11" } ] } ] }, { "description": "SEIZURES WITHOUT MCC", "code_information": [ { "code": "101", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 10640.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10640.73 } ] } ] }, { "description": "NM Adrenal Scan", "code_information": [ { "code": "78075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201.5, "discounted_cash": 372.0, "minimum": 360.45, "maximum": 1201.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1201.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1201.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1201.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1201.5 } ] } ] }, { "description": "Vitamin B2 (Riboflavin) Level", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.5, "discounted_cash": 116.0, "minimum": 112.65, "maximum": 340.5785, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 129.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 375.5, "10th_percentile": 375.5, "90th_percentile": 375.5, "count": "1 through 10" } ] } ] }, { "description": "AFB Culture with AFB Smear", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 56.0, "minimum": 54.9, "maximum": 165.981, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.8, "10th_percentile": 10.8, "90th_percentile": 10.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 40.08, "10th_percentile": 40.08, "90th_percentile": 58.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.48, "count": "1 through 10" } ] } ] }, { "description": "Creatinine Clearance Ur", "code_information": [ { "code": "82575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.5, "discounted_cash": 58.0, "minimum": 56.25, "maximum": 170.0625, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.18 } ] } ] }, { "description": "XR Esophagram Dbl 74221", "code_information": [ { "code": "74221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.75, "discounted_cash": 292.0, "minimum": 283.125, "maximum": 855.9813, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 400.61, "10th_percentile": 400.61, "90th_percentile": 400.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 396.11, "10th_percentile": 396.11, "90th_percentile": 396.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 308.04, "10th_percentile": 308.04, "90th_percentile": 308.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 651.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 302.0, "10th_percentile": 284.88, "90th_percentile": 302.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 302.0, "10th_percentile": 302.0, "90th_percentile": 302.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 302.0, "10th_percentile": 302.0, "90th_percentile": 302.0, "count": "1 through 10" } ] } ] }, { "description": "CT Angiography Abdomen w+wo Contrast", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1884.0, "discounted_cash": 584.0, "minimum": 565.2, "maximum": 1884.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 799.76, "10th_percentile": 799.76, "90th_percentile": 799.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1884.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1884.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1884.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 483.72, "10th_percentile": 483.72, "90th_percentile": 483.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 602.88, "10th_percentile": 602.88, "90th_percentile": 602.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 568.72, "10th_percentile": 568.72, "90th_percentile": 602.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 602.88, "10th_percentile": 602.88, "90th_percentile": 602.88, "count": "1 through 10" } ] } ] }, { "description": "TAP LUMBAR SPINE DX FAC", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 758.75, "discounted_cash": 235.0, "minimum": 227.625, "maximum": 688.1862, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 247.66, "10th_percentile": 247.66, "90th_percentile": 247.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 722.5, "10th_percentile": 722.5, "90th_percentile": 722.5, "count": "1 through 10" } ] } ] }, { "description": "Thyroxine, Total (T4)", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.25, "discounted_cash": 33.0, "minimum": 32.175, "maximum": 97.2758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 82.26, "10th_percentile": 82.26, "90th_percentile": 82.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.95 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 84.22, "10th_percentile": 84.22, "90th_percentile": 84.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 97.28, "10th_percentile": 97.28, "90th_percentile": 97.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "1 through 10" } ] } ] }, { "description": "NM Radiopharm Dacryocystography", "code_information": [ { "code": "78660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 990.0, "discounted_cash": 306.0, "minimum": 297.0, "maximum": 947.512, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 538.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 728.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 728.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.51 } ] } ] }, { "description": "Therapeutic Activity/15 min Lymphedema", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.5, "discounted_cash": 51.0, "minimum": 50.25, "maximum": 151.9225, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 47.42, "10th_percentile": 47.42, "90th_percentile": 47.42, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.6, "10th_percentile": 53.6, "90th_percentile": 268.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 107.2, "10th_percentile": 21.44, "90th_percentile": 375.2, "count": "1 through 10" } ] } ] }, { "description": "Zonisamide Level", "code_information": [ { "code": "80203", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.5, "discounted_cash": 53.0, "minimum": 51.45, "maximum": 155.5505, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.88, "10th_percentile": 54.88, "90th_percentile": 54.88, "count": "1 through 10" } ] } ] }, { "description": "XR Sacroiliac Joints 1-2 Views", "code_information": [ { "code": "72200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.25, "discounted_cash": 136.0, "minimum": 80.25, "maximum": 398.3997, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 135.29, "10th_percentile": 135.29, "90th_percentile": 135.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.32 } ] } ] }, { "description": "IR Pulmonary Unilateral Selective", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1338.25, "discounted_cash": 414.0, "minimum": 401.475, "maximum": 1213.7928, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 846.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1145.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1145.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.82 } ] } ] }, { "description": "MRI Femur Left w+wo Contrast", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2625.0, "discounted_cash": 813.0, "minimum": 787.5, "maximum": 2625.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2625.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2625.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2084.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 840.0, "10th_percentile": 840.0, "90th_percentile": 840.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 840.0, "10th_percentile": 840.0, "90th_percentile": 840.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 840.0, "10th_percentile": 840.0, "90th_percentile": 840.0, "count": "1 through 10" } ] } ] }, { "description": "US Infant Hips Limited", "code_information": [ { "code": "76886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408.75, "discounted_cash": 126.0, "minimum": 122.625, "maximum": 408.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 408.75 } ] } ] }, { "description": "Bill HLA DR Typing", "code_information": [ { "code": "86817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 687.25, "discounted_cash": 213.0, "minimum": 206.175, "maximum": 687.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 531.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 601.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 411.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 687.25 } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC", "code_information": [ { "code": "940", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 27549.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27549.67 } ] } ] }, { "description": "Therapeutic Exercise/Procedure/15 min OT", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 36.0, "minimum": 35.4, "maximum": 107.026, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 77.03, "10th_percentile": 77.03, "90th_percentile": 77.03, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.76, "10th_percentile": 37.76, "90th_percentile": 113.28, "count": "1 through 10" } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "664", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 12341.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12341.88 } ] } ] }, { "description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CCMCC", "code_information": [ { "code": "488", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 20853.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20853.53 } ] } ] }, { "description": "Spirometry w/o Bronchodilator", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.25, "discounted_cash": 105.0, "minimum": 101.775, "maximum": 307.6997, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.43, "10th_percentile": 105.43, "90th_percentile": 110.73, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.36, "10th_percentile": 103.36, "90th_percentile": 103.36, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9873.0, "minimum": 9873.95, "maximum": 21157.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21157.68 } ] } ] }, { "description": "PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "667", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 13040.97, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13040.97 } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 8653.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8653.11 } ] } ] }, { "description": "TP53 Somatic Mutation, Prognostic", "code_information": [ { "code": "81352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1800.0, "discounted_cash": 558.0, "minimum": 540.0, "maximum": 1800.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1800.0 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 59418.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59418.82 } ] } ] }, { "description": "Intrinsic Factor Blocking Antibody", "code_information": [ { "code": "86340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.75, "discounted_cash": 70.0, "minimum": 68.325, "maximum": 206.5693, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.72, "10th_percentile": 68.72, "90th_percentile": 72.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 196.71, "10th_percentile": 196.71, "90th_percentile": 196.71, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 72.88, "10th_percentile": 72.88, "90th_percentile": 72.88, "count": "1 through 10" } ] } ] }, { "description": "75716 FAC LE ANGIO IMAGING BILAT", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8207.75, "discounted_cash": 2544.0, "minimum": 609.1588, "maximum": 7444.4293, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1025.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1388.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1388.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.16 } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 49155.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49155.33 } ] } ] }, { "description": "75726 FAC ARTERY X-RAYS, ABDOMEN", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7482.0, "discounted_cash": 2319.0, "minimum": 657.1047, "maximum": 6786.174, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 917.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1242.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1242.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 657.1 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [ { "code": "154", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 18432.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18432.07 } ] } ] }, { "description": "TESTES PROCEDURES WITH CCMCC", "code_information": [ { "code": "711", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 24565.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24565.88 } ] } ] }, { "description": "Gabapentin Level", "code_information": [ { "code": "80171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.5, "discounted_cash": 173.0, "minimum": 79.26, "maximum": 506.5595, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.0 } ] } ] }, { "description": "Sensory Integration/15 min OT", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.75, "discounted_cash": 25.0, "minimum": 25.125, "maximum": 83.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.75 } ] } ] }, { "description": "Reticulocyte, %", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.75, "discounted_cash": 31.0, "minimum": 25.63, "maximum": 93.1942, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 75.08, "10th_percentile": 75.08, "90th_percentile": 103.35, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.65, "10th_percentile": 43.65, "90th_percentile": 46.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 31.66, "10th_percentile": 31.66, "90th_percentile": 33.54, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.63 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 65.35, "10th_percentile": 65.35, "90th_percentile": 65.35, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 102.75, "10th_percentile": 97.0, "90th_percentile": 102.75, "count": "29" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 31.04, "10th_percentile": 31.04, "90th_percentile": 32.88, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 32.88, "10th_percentile": 31.04, "90th_percentile": 93.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.88, "10th_percentile": 31.04, "90th_percentile": 32.88, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 31.04, "10th_percentile": 31.04, "90th_percentile": 31.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 31.04, "10th_percentile": 31.04, "90th_percentile": 32.88, "count": "1 through 10" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 12951.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12951.37 } ] } ] }, { "description": "IR Adrenal Artery Scan Bilateral S+I", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1307.25, "discounted_cash": 405.0, "minimum": 392.175, "maximum": 1307.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1057.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1307.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1307.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 950.38 } ] } ] }, { "description": "NM Lung Quant Perf Only", "code_information": [ { "code": "78597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 713.25, "discounted_cash": 221.0, "minimum": 213.975, "maximum": 713.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 656.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 713.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 713.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.25 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [ { "code": "696", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 8122.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8122.61 } ] } ] }, { "description": "Type, Body Fluid", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.25, "discounted_cash": 39.0, "minimum": 35.23, "maximum": 115.4158, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.17, "10th_percentile": 39.17, "90th_percentile": 39.17, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.4, "10th_percentile": 5.6, "90th_percentile": 38.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 40.72, "10th_percentile": 40.72, "90th_percentile": 40.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.4, "10th_percentile": 38.4, "90th_percentile": 38.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.4, "10th_percentile": 38.4, "90th_percentile": 38.4, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC", "code_information": [ { "code": "657", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 21573.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21573.83 } ] } ] }, { "description": "Continuous Nebulizer Treatment Subsequent", "code_information": [ { "code": "94645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 432.25, "discounted_cash": 133.0, "minimum": 129.675, "maximum": 392.0507, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.76, "10th_percentile": 131.76, "90th_percentile": 131.76, "count": "1 through 10" } ] } ] }, { "description": "Protein S, Functional", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.5, "discounted_cash": 153.0, "minimum": 91.44, "maximum": 450.3255, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 158.88, "10th_percentile": 158.88, "90th_percentile": 158.88, "count": "1 through 10" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 36654.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36654.3 } ] } ] }, { "description": "36591 COLLECT FROM VAD", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.5, "discounted_cash": 9.0, "minimum": 9.45, "maximum": 28.5705, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 20.39, "10th_percentile": 20.39, "90th_percentile": 20.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.28, "10th_percentile": 10.28, "90th_percentile": 10.28, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 31.5, "10th_percentile": 30.0, "90th_percentile": 31.5, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.08, "10th_percentile": 9.6, "90th_percentile": 10.08, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 10.08, "10th_percentile": 9.6, "90th_percentile": 28.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.6, "10th_percentile": 9.6, "90th_percentile": 262.17, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.08, "10th_percentile": 9.6, "90th_percentile": 10.08, "count": "13" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.08, "count": "1 through 10" } ] } ] }, { "description": "Cyclosporine A", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.5, "discounted_cash": 83.0, "minimum": 80.85, "maximum": 244.4365, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.24, "count": "21" } ] } ] }, { "description": "PNEUMOTHORAX WITH CC", "code_information": [ { "code": "200", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 12959.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12959.63 } ] } ] }, { "description": "Carbon Monoxide Diffusion Cap", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.0, "discounted_cash": 90.0, "minimum": 87.3, "maximum": 263.937, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 214.59, "10th_percentile": 214.59, "90th_percentile": 223.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 130.95, "10th_percentile": 124.76, "90th_percentile": 130.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 192.76, "10th_percentile": 150.77, "90th_percentile": 192.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 94.98, "10th_percentile": 90.49, "90th_percentile": 94.98, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 227.07, "10th_percentile": 227.07, "90th_percentile": 227.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 221.91, "10th_percentile": 221.91, "90th_percentile": 221.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 232.16, "10th_percentile": 232.16, "90th_percentile": 232.16, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 291.0, "10th_percentile": 277.25, "90th_percentile": 291.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 223.2, "10th_percentile": 223.2, "90th_percentile": 223.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 291.0, "10th_percentile": 277.25, "90th_percentile": 291.0, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.72, "10th_percentile": 88.72, "90th_percentile": 93.12, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 422.05, "10th_percentile": 263.94, "90th_percentile": 645.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 376.91, "10th_percentile": 153.22, "90th_percentile": 533.81, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.72, "10th_percentile": 88.72, "90th_percentile": 93.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.72, "10th_percentile": 88.72, "90th_percentile": 88.72, "count": "1 through 10" } ] } ] }, { "description": "Varicella Ab, IgG", "code_information": [ { "code": "86787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.75, "discounted_cash": 47.0, "minimum": 45.825, "maximum": 138.5443, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 47.0, "10th_percentile": 47.0, "90th_percentile": 47.0, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.42 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 91.58, "10th_percentile": 91.58, "90th_percentile": 91.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 152.75, "10th_percentile": 144.0, "90th_percentile": 240.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 46.08, "count": "1 through 10" } ] } ] }, { "description": "NM MUGA Gated Cardiac Single Planar", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1234.5, "discounted_cash": 382.0, "minimum": 370.35, "maximum": 1234.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1234.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 843.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1141.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1141.74 } ] } ] }, { "description": "$ Cannabinoid Confirmation", "code_information": [ { "code": "80349", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.75, "discounted_cash": 106.0, "minimum": 103.125, "maximum": 311.7813, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.1 } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH MCC", "code_information": [ { "code": "619", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 34039.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34039.5 } ] } ] }, { "description": "NM Gastric Emptying", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.5, "discounted_cash": 273.0, "minimum": 265.05, "maximum": 883.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 883.5, "10th_percentile": 883.5, "90th_percentile": 883.5, "count": "1 through 10" } ] } ] }, { "description": "SLP Auditory Processing Tx Units", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.25, "discounted_cash": 112.0, "minimum": 95.0, "maximum": 330.3748, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": ".CD4 Absolute Count Only", "code_information": [ { "code": "86361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.75, "discounted_cash": 78.0, "minimum": 70.37, "maximum": 249.6324, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.52, "10th_percentile": 65.52, "90th_percentile": 65.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 249.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 200.75, "10th_percentile": 200.75, "90th_percentile": 212.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 64.24, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "624", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 14758.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14758.62 } ] } ] }, { "description": "NM Bone SPECT CT 78830", "code_information": [ { "code": "78830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6165.25, "discounted_cash": 1911.0, "minimum": 1849.575, "maximum": 5591.8817, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3121.81 } ] } ] }, { "description": "US Echo Encephalogram", "code_information": [ { "code": "76506", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.25, "discounted_cash": 159.0, "minimum": 153.975, "maximum": 513.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 252.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 513.25 } ] } ] }, { "description": "Ther Ivntj EA Addl 15 Min OT", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.0, "discounted_cash": 28.0, "minimum": 27.9, "maximum": 93.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.0 } ] } ] }, { "description": "PT Re-Evaluation Units, 97164", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.5, "discounted_cash": 78.0, "minimum": 76.05, "maximum": 229.9245, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "582", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 22712.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22712.65 } ] } ] }, { "description": "NM Thallium 201 MCI", "code_information": [ { "code": "A9505", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.25, "minimum": 87.975, "maximum": 265.9778, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.55 } ] } ] }, { "description": ".Hu Ab, Western Blot,Serum", "code_information": [ { "code": "84181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.25, "discounted_cash": 66.0, "minimum": 64.275, "maximum": 194.3247, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 159.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.75 } ] } ] }, { "description": "ACTH", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 459.5, "discounted_cash": 142.0, "minimum": 137.85, "maximum": 416.7665, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 318.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 360.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.12 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 292.24, "10th_percentile": 292.24, "90th_percentile": 584.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 360.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 459.5, "10th_percentile": 459.5, "90th_percentile": 459.5, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 147.04, "10th_percentile": 147.04, "90th_percentile": 147.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 416.77, "10th_percentile": 416.77, "90th_percentile": 416.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 147.04, "10th_percentile": 147.04, "90th_percentile": 147.04, "count": "1 through 10" } ] } ] }, { "description": "SPINAL PROCEDURES WITH MCC", "code_information": [ { "code": "028", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20391.0, "minimum": 20391.85, "maximum": 70831.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70831.73 } ] } ] }, { "description": "Vanco", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.25, "discounted_cash": 111.0, "minimum": 86.67, "maximum": 324.9327, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 116.93, "10th_percentile": 116.93, "90th_percentile": 116.93, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.21 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 108.16, "10th_percentile": 108.16, "90th_percentile": 108.16, "count": "1 through 10" } ] } ] }, { "description": "Bill IBD sgi DNAse Sensitivity", "code_information": [ { "code": "88350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.75, "discounted_cash": 61.0, "minimum": 59.625, "maximum": 198.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.75 } ] } ] }, { "description": "US AAA Screening", "code_information": [ { "code": "76706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.25, "discounted_cash": 218.0, "minimum": 211.875, "maximum": 685.2439, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 541.69, "10th_percentile": 541.69, "90th_percentile": 541.69, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 317.81, "10th_percentile": 299.81, "90th_percentile": 317.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 522.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 217.46, "10th_percentile": 217.46, "90th_percentile": 230.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 522.83 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 533.27, "10th_percentile": 533.27, "90th_percentile": 533.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 685.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 226.0, "10th_percentile": 213.2, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 226.0, "10th_percentile": 226.0, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 213.2, "10th_percentile": 213.2, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 226.0, "10th_percentile": 226.0, "90th_percentile": 226.0, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [ { "code": "597", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 19653.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19653.41 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "393", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9015.0, "minimum": 6912.1428, "maximum": 18854.12, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9015.34, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 19183.95, "10th_percentile": 19183.95, "90th_percentile": 19183.95, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18854.12 } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [ { "code": "481", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 24692.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24692.02 } ] } ] }, { "description": "NM Thyroid Carcinoma Mets Uptake", "code_information": [ { "code": "78020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430.0, "discounted_cash": 133.0, "minimum": 129.0, "maximum": 430.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 243.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 329.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 329.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 430.0 } ] } ] }, { "description": "Gastroccult", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.5, "discounted_cash": 15.0, "minimum": 14.85, "maximum": 49.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.84, "10th_percentile": 15.84, "90th_percentile": 15.84, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 12664.41, "maximum": 26828.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26828.18 } ] } ] }, { "description": "5 Nucleotidase", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.0, "discounted_cash": 36.0, "minimum": 35.1, "maximum": 106.119, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.94 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "143", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13308.0, "minimum": 13308.36, "maximum": 44168.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44168.59 } ] } ] }, { "description": "Bilirubin, Conjugated", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 11.0, "minimum": 11.325, "maximum": 37.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 28.95, "10th_percentile": 28.95, "90th_percentile": 28.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.99, "10th_percentile": 16.99, "90th_percentile": 16.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.32, "10th_percentile": 12.32, "90th_percentile": 12.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.12 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 24.01, "10th_percentile": 24.01, "90th_percentile": 24.01, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 30.22, "10th_percentile": 30.22, "90th_percentile": 30.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.58, "10th_percentile": 26.58, "90th_percentile": 26.58, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 28.95, "10th_percentile": 28.95, "90th_percentile": 28.95, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 37.75, "10th_percentile": 37.75, "90th_percentile": 37.75, "count": "19" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 34.24, "10th_percentile": 12.08, "90th_percentile": 34.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" } ] } ] }, { "description": "Blood Type Rh", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.25, "discounted_cash": 14.0, "minimum": 13.875, "maximum": 41.9487, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 35.8, "10th_percentile": 35.8, "90th_percentile": 35.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.81, "10th_percentile": 20.81, "90th_percentile": 20.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.1, "10th_percentile": 15.1, "90th_percentile": 15.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 37.88, "10th_percentile": 37.88, "90th_percentile": 37.88, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 37.02, "10th_percentile": 37.02, "90th_percentile": 37.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.25, "10th_percentile": 46.25, "90th_percentile": 46.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 30.76, "10th_percentile": 30.76, "90th_percentile": 30.76, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 46.25, "10th_percentile": 46.25, "90th_percentile": 46.25, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 14.8, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 41.95, "10th_percentile": 14.8, "90th_percentile": 42.37, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 14.8, "count": "50" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 14.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 14.8, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITHOUT CCMCC", "code_information": [ { "code": "798", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 11283.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11283.23 } ] } ] }, { "description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CCMCC", "code_information": [ { "code": "538", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 8491.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8491.6 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 54447.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54447.4 } ] } ] }, { "description": "XR Arthrogram Hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 409.75, "discounted_cash": 127.0, "minimum": 122.925, "maximum": 409.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 274.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 371.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 371.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 409.75 } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 9704.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9704.69 } ] } ] }, { "description": "MINOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "606", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 17839.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17839.08 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITHOUT CCMCC", "code_information": [ { "code": "293", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 19379.1751, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6672.56 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "723", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 13471.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13471.27 } ] } ] }, { "description": "36592 COLLECT FROM ES", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.5, "discounted_cash": 9.0, "minimum": 9.45, "maximum": 28.5705, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 28.57, "10th_percentile": 28.57, "90th_percentile": 28.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.08, "count": "12" } ] } ] }, { "description": "IV Infusion Initial up to 1 Hr", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 815.25, "discounted_cash": 252.0, "minimum": 244.575, "maximum": 739.4317, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 428.09, "10th_percentile": 428.09, "90th_percentile": 428.09, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 366.86, "10th_percentile": 366.86, "90th_percentile": 366.86, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 540.02, "10th_percentile": 540.02, "90th_percentile": 540.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 266.1, "10th_percentile": 266.1, "90th_percentile": 266.1, "count": "24" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 680.22, "10th_percentile": 260.88, "90th_percentile": 815.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 542.14, "10th_percentile": 542.14, "90th_percentile": 542.14, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 815.25, "10th_percentile": 815.25, "90th_percentile": 815.25, "count": "85" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 260.88, "10th_percentile": 260.88, "90th_percentile": 260.88, "count": "64" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 260.88, "10th_percentile": 260.88, "90th_percentile": 746.77, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 260.88, "10th_percentile": 260.88, "90th_percentile": 260.88, "count": "57" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 260.88, "10th_percentile": 260.88, "90th_percentile": 260.88, "count": "17" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 260.88, "10th_percentile": 260.88, "90th_percentile": 260.88, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL C1889) IMPLANT/INSERT DEVICE, NOC - C1889 - 27201889", "code_information": [ { "code": "C1889", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 238.92, "10th_percentile": 124.7, "90th_percentile": 1452.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.88, "10th_percentile": 56.88, "90th_percentile": 373.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 1212.06, "10th_percentile": 1212.06, "90th_percentile": 1212.06, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1068.5, "10th_percentile": 351.5, "90th_percentile": 2286.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 341.92, "10th_percentile": 120.32, "90th_percentile": 683.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 5511.59, "10th_percentile": 5511.59, "90th_percentile": 5511.59, "count": "1 through 10" } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [ { "code": "405", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18030.0, "minimum": 18030.68, "maximum": 64491.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64491.62 } ] } ] }, { "description": "NM CR Phosphate P32 per MCI", "code_information": [ { "code": "A9564", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.25, "minimum": 1.0, "maximum": 285.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.25 } ] } ] }, { "description": "Mercury Level, Blood", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.25, "discounted_cash": 72.0, "minimum": 70.275, "maximum": 212.4648, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.96, "10th_percentile": 74.96, "90th_percentile": 74.96, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 234.25, "10th_percentile": 234.25, "90th_percentile": 234.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 212.47, "10th_percentile": 212.47, "90th_percentile": 212.47, "count": "1 through 10" } ] } ] }, { "description": "Rad Ther Room Level 5", "code_information": [ { "code": "99215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.75, "discounted_cash": 83.0, "minimum": 80.325, "maximum": 242.8493, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 112.39, "10th_percentile": 112.39, "90th_percentile": 112.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 76.05, "10th_percentile": 76.05, "90th_percentile": 76.05, "count": "90" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 55.16, "10th_percentile": 55.16, "90th_percentile": 55.16, "count": "115" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.41, "10th_percentile": 54.08, "90th_percentile": 169.0, "count": "110" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 120.51, "10th_percentile": 118.08, "90th_percentile": 120.51, "count": "177" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 64.24, "count": "247" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 160.41, "10th_percentile": 63.66, "90th_percentile": 214.49, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.41, "10th_percentile": 10.82, "90th_percentile": 211.55, "count": "242" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.24, "10th_percentile": 54.08, "90th_percentile": 64.24, "count": "34" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 64.24, "count": "84" } ] } ] }, { "description": "SIM REP TRK 12.6-20 FAC", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 466.75, "discounted_cash": 144.0, "minimum": 140.025, "maximum": 423.3422, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 358.0, "10th_percentile": 358.0, "90th_percentile": 358.0, "count": "1 through 10" } ] } ] }, { "description": "MRI Toes Left 73721", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2306.0, "discounted_cash": 714.0, "minimum": 691.8, "maximum": 2091.542, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1652.3, "10th_percentile": 1637.35, "90th_percentile": 1652.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 960.64, "10th_percentile": 432.4, "90th_percentile": 960.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 696.78, "10th_percentile": 696.78, "90th_percentile": 696.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1708.65, "10th_percentile": 1676.42, "90th_percentile": 1708.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1223.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2134.75, "10th_percentile": 2134.75, "90th_percentile": 2134.75, "count": "17" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 661.77, "90th_percentile": 683.12, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1936.22, "10th_percentile": 1936.22, "90th_percentile": 1936.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 614.96, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" } ] } ] }, { "description": "PT Appl Multilay Comprs Arm/Hand Unit", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 482.0, "discounted_cash": 149.0, "minimum": 95.0, "maximum": 437.174, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "PSA (Prostate Specific Antigen) - 84153 - 3350213", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 57.0, "minimum": 55.5, "maximum": 171.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 123.03, "10th_percentile": 123.03, "90th_percentile": 123.03, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.25, "10th_percentile": 83.25, "90th_percentile": 83.25, "count": "30" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.38, "10th_percentile": 60.38, "90th_percentile": 60.38, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 117.66, "10th_percentile": 117.66, "90th_percentile": 117.66, "count": "28" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 148.07, "10th_percentile": 145.28, "90th_percentile": 148.07, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 153.84, "10th_percentile": 37.44, "90th_percentile": 185.0, "count": "11" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 166.28, "10th_percentile": 166.28, "90th_percentile": 171.77, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 185.0, "10th_percentile": 185.0, "90th_percentile": 185.0, "count": "36" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "85" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 167.8, "10th_percentile": 59.2, "90th_percentile": 169.46, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "53" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "1 through 10" } ] } ] }, { "description": "Caffeine lvl", "code_information": [ { "code": "80155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.75, "discounted_cash": 120.0, "minimum": 84.56, "maximum": 359.5341, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 359.53 } ] } ] }, { "description": "XR Bone Age Study", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504.75, "discounted_cash": 156.0, "minimum": 55.46, "maximum": 457.8082, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 368.62, "10th_percentile": 368.62, "90th_percentile": 368.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.09 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 302.9, "10th_percentile": 302.9, "90th_percentile": 302.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 476.25, "10th_percentile": 476.25, "90th_percentile": 504.75, "count": "1 through 10" } ] } ] }, { "description": "XR Hip Bilateral w Pelvis 5+ Views 73523", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 543.75, "discounted_cash": 168.0, "minimum": 163.125, "maximum": 493.1812, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 341.15, "10th_percentile": 341.15, "90th_percentile": 341.15, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 360.18, "10th_percentile": 360.18, "90th_percentile": 360.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 167.44, "10th_percentile": 167.44, "90th_percentile": 177.48, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 345.83, "10th_percentile": 345.83, "90th_percentile": 345.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.64 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 543.75, "10th_percentile": 513.0, "90th_percentile": 543.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 164.16, "10th_percentile": 164.16, "90th_percentile": 168.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 493.18, "10th_percentile": 493.18, "90th_percentile": 493.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 174.0, "10th_percentile": 164.16, "90th_percentile": 310.81, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 164.16, "10th_percentile": 164.16, "90th_percentile": 164.16, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 8800.69, "maximum": 19421.8994, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18910.7 } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [ { "code": "299", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 19247.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19247.87 } ] } ] }, { "description": "PENIS PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "710", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3434.0, "minimum": 3434.42, "maximum": 16518.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16518.72 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 8248.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8248.75 } ] } ] }, { "description": "Famotidine Inj 20 MG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323073916", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 57.91, "10th_percentile": 57.91, "90th_percentile": 57.91, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 29.43, "10th_percentile": 29.43, "90th_percentile": 29.43, "count": "1 through 10" } ] } ] }, { "description": "PNEUMOTHORAX WITHOUT CCMCC", "code_information": [ { "code": "201", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 8430.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8430.3 } ] } ] }, { "description": "XR Chest 1 View 71045", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.25, "discounted_cash": 79.0, "minimum": 43.68, "maximum": 231.5118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 195.78, "10th_percentile": 195.78, "90th_percentile": 197.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 114.86, "10th_percentile": 114.86, "90th_percentile": 114.86, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.31, "10th_percentile": 83.31, "90th_percentile": 83.31, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.42 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 209.05, "10th_percentile": 209.05, "90th_percentile": 209.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 200.45, "10th_percentile": 200.45, "90th_percentile": 204.3, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 255.25, "10th_percentile": 255.25, "90th_percentile": 255.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 255.25, "10th_percentile": 255.25, "90th_percentile": 255.25, "count": "42" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 238.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "11" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "1 through 10" } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "422", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 16498.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16498.68 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22753.0, "minimum": 22753.01, "maximum": 115329.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 115329.23 } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "255", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14596.0, "minimum": 14596.27, "maximum": 31799.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31799.59 } ] } ] }, { "description": "XR Orbits 4 Views", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 587.25, "discounted_cash": 182.0, "minimum": 119.61, "maximum": 532.6358, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 161.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 161.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 293.28 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 45631.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45631.6 } ] } ] }, { "description": "TB INTRADERMAL", "code_information": [ { "code": "86580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.25, "discounted_cash": 11.0, "minimum": 11.175, "maximum": 37.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.25 } ] } ] }, { "description": "CT Pelvis w+wo Contrast", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2669.0, "discounted_cash": 827.0, "minimum": 650.0, "maximum": 2420.783, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1868.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1868.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1714.58 } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "923", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 1690.3864, "maximum": 11997.64, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6010.23, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2291.58, "10th_percentile": 2291.58, "90th_percentile": 2291.58, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11997.64 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "722", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10732.0, "minimum": 10732.55, "maximum": 21334.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21334.52 } ] } ] }, { "description": "CRP (C-Reactive Protein)", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.25, "discounted_cash": 36.0, "minimum": 33.12, "maximum": 107.2528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 74.15, "10th_percentile": 74.15, "90th_percentile": 74.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.21, "10th_percentile": 50.18, "90th_percentile": 53.21, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.6, "10th_percentile": 36.39, "90th_percentile": 38.6, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 75.21, "10th_percentile": 70.91, "90th_percentile": 91.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 89.24, "10th_percentile": 89.24, "90th_percentile": 92.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.25, "10th_percentile": 67.28, "90th_percentile": 118.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 90.7, "10th_percentile": 90.7, "90th_percentile": 90.7, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 111.5, "10th_percentile": 111.5, "90th_percentile": 118.25, "count": "121" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.84, "10th_percentile": 5.18, "90th_percentile": 37.84, "count": "81" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 107.25, "10th_percentile": 35.68, "90th_percentile": 108.32, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.84, "count": "35" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.84, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.68, "10th_percentile": 35.68, "90th_percentile": 37.84, "count": "11" } ] } ] }, { "description": "SKIN ULCERS WITHOUT CCMCC", "code_information": [ { "code": "594", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 10218.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10218.69 } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 21542.8554, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7399.94 } ] } ] }, { "description": "Calreticulin (CALR) Mutation Analysis", "code_information": [ { "code": "81219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1281.25, "discounted_cash": 397.0, "minimum": 384.375, "maximum": 1162.0938, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 936.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1059.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 725.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1133.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 326.0, "10th_percentile": 326.0, "90th_percentile": 326.0, "count": "1 through 10" } ] } ] }, { "description": "MA Breast Diag Tomo Bilat 77066 77062", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.75, "discounted_cash": 186.0, "minimum": 180.825, "maximum": 602.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 462.31, "10th_percentile": 462.31, "90th_percentile": 462.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 271.24, "10th_percentile": 271.24, "90th_percentile": 271.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 492.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 602.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 602.75 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 473.34, "10th_percentile": 473.34, "90th_percentile": 473.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 602.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 192.88, "10th_percentile": 192.88, "90th_percentile": 192.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 103.23, "10th_percentile": 102.37, "90th_percentile": 103.23, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 192.88, "10th_percentile": 192.88, "90th_percentile": 192.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 192.88, "10th_percentile": 192.88, "90th_percentile": 192.88, "count": "1 through 10" } ] } ] }, { "description": "Hepatitis B Surface Antibody", "code_information": [ { "code": "86706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.25, "discounted_cash": 33.0, "minimum": 32.775, "maximum": 100.114, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.91 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 82.44, "10th_percentile": 82.44, "90th_percentile": 82.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 103.0, "10th_percentile": 103.0, "90th_percentile": 109.25, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.96, "10th_percentile": 32.96, "90th_percentile": 32.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.96, "10th_percentile": 32.96, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 68.5, "10th_percentile": 68.5, "90th_percentile": 68.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.16, "10th_percentile": 49.16, "90th_percentile": 49.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.32 } ] } ] }, { "description": "XR Leg Lower Left 2 Views", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 394.75, "discounted_cash": 122.0, "minimum": 72.93, "maximum": 358.0383, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 302.77, "10th_percentile": 302.77, "90th_percentile": 302.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.85, "10th_percentile": 128.85, "90th_percentile": 128.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 305.08, "10th_percentile": 305.08, "90th_percentile": 305.08, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 298.15, "10th_percentile": 298.15, "90th_percentile": 298.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 394.75, "10th_percentile": 372.5, "90th_percentile": 394.75, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 122.37, "10th_percentile": 119.2, "90th_percentile": 126.32, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 358.04, "10th_percentile": 326.5, "90th_percentile": 358.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 126.32, "10th_percentile": 119.2, "90th_percentile": 360.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.2, "10th_percentile": 119.2, "90th_percentile": 119.2, "count": "1 through 10" } ] } ] }, { "description": "Herpes Simplex Virus by PCR", "code_information": [ { "code": "87529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.25, "discounted_cash": 82.0, "minimum": 79.875, "maximum": 266.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 201.1, "10th_percentile": 201.1, "90th_percentile": 201.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 85.2, "10th_percentile": 85.2, "90th_percentile": 85.2, "count": "1 through 10" } ] } ] }, { "description": "75894 FAC TRANSCATH TX EMBOLIZATION", "code_information": [ { "code": "75894", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4059.25, "discounted_cash": 1258.0, "minimum": 1217.775, "maximum": 4059.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3644.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4059.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4059.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4059.25 } ] } ] }, { "description": "Rad Ther Iodine 125 per MCI", "code_information": [ { "code": "A9527", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.75, "minimum": 47.925, "maximum": 159.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.75 } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC", "code_information": [ { "code": "456", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20177.0, "minimum": 20177.19, "maximum": 99067.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 99067.51 } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CCMCC", "code_information": [ { "code": "482", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 19227.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19227.83 } ] } ] }, { "description": "Vitamin B12 Level", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.5, "discounted_cash": 67.0, "minimum": 65.25, "maximum": 197.2725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 144.64, "10th_percentile": 144.64, "90th_percentile": 144.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.88, "10th_percentile": 97.88, "90th_percentile": 97.88, "count": "23" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.99, "10th_percentile": 70.99, "90th_percentile": 70.99, "count": "30" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.74 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 138.33, "10th_percentile": 138.33, "90th_percentile": 138.33, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 170.8, "10th_percentile": 170.8, "90th_percentile": 170.8, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 157.3, "10th_percentile": 19.72, "90th_percentile": 217.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 166.82, "10th_percentile": 144.64, "90th_percentile": 166.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 217.5, "10th_percentile": 217.5, "90th_percentile": 217.5, "count": "103" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 69.6, "count": "129" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 197.27, "10th_percentile": 69.6, "90th_percentile": 199.23, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 69.6, "count": "75" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 69.6, "count": "16" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 69.6, "count": "1 through 10" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "831", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 14176.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14176.25 } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES WITH CCMCC", "code_information": [ { "code": "707", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 23581.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23581.5 } ] } ] }, { "description": ".stratify JCV Ab Inhibition", "code_information": [ { "code": "86711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1712.75, "discounted_cash": 530.0, "minimum": 86.71, "maximum": 1553.4642, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.44 } ] } ] }, { "description": "MRI Breast Right w Contrast 77048", "code_information": [ { "code": "77048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 939.0, "discounted_cash": 291.0, "minimum": 281.7, "maximum": 939.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 939.0 } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITH MCC", "code_information": [ { "code": "385", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 18653.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18653.7 } ] } ] }, { "description": "XR Mandible 1-3 Views", "code_information": [ { "code": "70100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 536.0, "discounted_cash": 166.0, "minimum": 84.62, "maximum": 486.152, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 505.75, "10th_percentile": 505.75, "90th_percentile": 505.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 308.33, "10th_percentile": 308.33, "90th_percentile": 308.33, "count": "1 through 10" } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC", "code_information": [ { "code": "062", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 20715.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20715.6 } ] } ] }, { "description": "B miyamotoi Ab IgG", "code_information": [ { "code": "86619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 222.0, "discounted_cash": 68.0, "minimum": 66.6, "maximum": 201.354, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.72 } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 8800.69, "maximum": 53786.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53786.04 } ] } ] }, { "description": "U Porphobilinogens, Random - 84110 - 3358879 - 3358879", "code_information": [ { "code": "84110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 365.0, "discounted_cash": 113.0, "minimum": 44.65, "maximum": 331.055, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.67 } ] } ] }, { "description": "EBV Early Ab, IgG", "code_information": [ { "code": "86663", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.25, "discounted_cash": 51.0, "minimum": 49.575, "maximum": 149.8818, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 83.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.3 } ] } ] }, { "description": "OSTEOMYELITIS WITH MCC", "code_information": [ { "code": "539", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13308.0, "minimum": 13308.36, "maximum": 33099.4004, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 13907.22, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 16761.36, "10th_percentile": 16761.36, "90th_percentile": 16761.36, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23220.75 } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "185", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 9272.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9272.03 } ] } ] }, { "description": "Presence of Sperm Post Vasectomy", "code_information": [ { "code": "89321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.75, "discounted_cash": 24.0, "minimum": 23.625, "maximum": 78.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.75 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 19214.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19214.86 } ] } ] }, { "description": "TPMT Enzyme, Prometheus", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.5, "discounted_cash": 94.0, "minimum": 91.35, "maximum": 276.1815, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.54 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 243.72, "10th_percentile": 243.72, "90th_percentile": 243.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.66 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.44, "10th_percentile": 97.44, "90th_percentile": 97.44, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 17022.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17022.11 } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [ { "code": "558", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 2511.8117, "maximum": 10529.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10529.92 } ] } ] }, { "description": "ORBITAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "114", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 15950.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15950.49 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 15010.6301, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6224.88, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 14920.85, "10th_percentile": 10657.75, "90th_percentile": 17052.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 15010.63, "standard_charge_algorithm": "90.7% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 10657.75, "10th_percentile": 10657.75, "90th_percentile": 10657.75, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9477.16 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "357", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 9444.64, "maximum": 27415.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27415.27 } ] } ] }, { "description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [ { "code": "189", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7512.0, "minimum": 7512.79, "maximum": 14564.11, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7512.79, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6874.74, "10th_percentile": 2291.58, "90th_percentile": 9856.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 7512.79, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4630.0, "10th_percentile": 4630.0, "90th_percentile": 18384.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14564.11 } ] } ] }, { "description": "XR Wrist Left 3-4 Views", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.25, "discounted_cash": 120.0, "minimum": 99.18, "maximum": 353.9567, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 299.32, "10th_percentile": 285.03, "90th_percentile": 598.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 175.61, "10th_percentile": 165.71, "90th_percentile": 175.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.38, "10th_percentile": 120.2, "90th_percentile": 127.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 134.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 301.6, "10th_percentile": 234.21, "90th_percentile": 319.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 294.75, "10th_percentile": 294.75, "90th_percentile": 294.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 171.05, "10th_percentile": 117.84, "90th_percentile": 326.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 390.25, "10th_percentile": 368.25, "90th_percentile": 390.25, "count": "54" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 124.88, "10th_percentile": 117.84, "90th_percentile": 124.88, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 353.96, "10th_percentile": 353.96, "90th_percentile": 353.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 219.92, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 117.84, "10th_percentile": 117.84, "90th_percentile": 117.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 124.88, "count": "1 through 10" } ] } ] }, { "description": "Rituxan Sensitivity (CD20)", "code_information": [ { "code": "86356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.25, "discounted_cash": 95.0, "minimum": 70.37, "maximum": 278.6757, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 249.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 92.72, "10th_percentile": 92.72, "90th_percentile": 92.72, "count": "1 through 10" } ] } ] }, { "description": "SLP Speech AAC Eval First Hour Units", "code_information": [ { "code": "92607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.5, "discounted_cash": 158.0, "minimum": 95.0, "maximum": 463.0235, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Hep C Viral RNA Ns5a Drug Resist", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2603.25, "discounted_cash": 807.0, "minimum": 526.31, "maximum": 2399.8459, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 3801.89, "10th_percentile": 3801.89, "90th_percentile": 3801.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 679.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 768.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 526.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2399.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1334.0, "10th_percentile": 1334.0, "90th_percentile": 2603.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 833.04, "10th_percentile": 833.04, "90th_percentile": 833.04, "count": "1 through 10" } ] } ] }, { "description": "Specific Gravity, Body Fluid", "code_information": [ { "code": "84315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.75, "discounted_cash": 12.0, "minimum": 12.525, "maximum": 37.8672, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.57 } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [ { "code": "181", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 15837.2721, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12626.0 } ] } ] }, { "description": "CT Sinuses w+wo Contrast", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1999.25, "discounted_cash": 619.0, "minimum": 599.775, "maximum": 1866.73, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1866.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1866.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1097.02 } ] } ] }, { "description": "PLEURAL EFFUSION WITHOUT CCMCC", "code_information": [ { "code": "188", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 8455.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8455.06 } ] } ] }, { "description": "Trazodone (Desyrel) Level", "code_information": [ { "code": "80338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.5, "discounted_cash": 108.0, "minimum": 105.15, "maximum": 317.9035, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.85 } ] } ] }, { "description": "MRI Angio Lower Ext Left wo + w Contrast", "code_information": [ { "code": "73725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3767.0, "discounted_cash": 1167.0, "minimum": 900.0, "maximum": 3416.669, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2342.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2342.79 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2210.91 } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [ { "code": "867", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11591.0, "minimum": 11591.15, "maximum": 24676.69, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 11591.15, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11457.9, "10th_percentile": 11457.9, "90th_percentile": 11457.9, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24676.69 } ] } ] }, { "description": "XR Sella Turcica", "code_information": [ { "code": "70240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 421.25, "discounted_cash": 130.0, "minimum": 77.3, "maximum": 382.0738, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.05 } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49155.0, "minimum": 49155.08, "maximum": 250223.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 250223.46 } ] } ] }, { "description": "Assistive Tech Assessment/15 min OT", "code_information": [ { "code": "97755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.5, "discounted_cash": 56.0, "minimum": 54.45, "maximum": 164.6205, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "XR Pelvis 2 Views", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 579.75, "discounted_cash": 179.0, "minimum": 68.56, "maximum": 525.8333, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 222.78, "10th_percentile": 222.78, "90th_percentile": 222.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 260.89, "10th_percentile": 260.89, "90th_percentile": 260.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 68.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 115.87, "10th_percentile": 115.87, "90th_percentile": 115.87, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 335.0, "10th_percentile": 335.0, "90th_percentile": 355.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 107.2, "10th_percentile": 107.2, "90th_percentile": 107.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 306.86, "10th_percentile": 306.86, "90th_percentile": 306.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 107.2, "10th_percentile": 107.2, "90th_percentile": 113.6, "count": "1 through 10" } ] } ] }, { "description": "XR Cervical Spine Portable Lateral", "code_information": [ { "code": "72020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.25, "discounted_cash": 105.0, "minimum": 62.74, "maximum": 309.5138, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 322.0, "10th_percentile": 322.0, "90th_percentile": 322.0, "count": "1 through 10" } ] } ] }, { "description": "TX FX TOE MANIP FAC", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.5, "discounted_cash": 105.0, "minimum": 101.85, "maximum": 307.9265, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 339.5, "10th_percentile": 339.5, "90th_percentile": 339.5, "count": "1 through 10" } ] } ] }, { "description": "MNT Initial", "code_information": [ { "code": "97802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.25, "discounted_cash": 37.0, "minimum": 36.375, "maximum": 109.9737, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 277.67, "10th_percentile": 222.14, "90th_percentile": 277.67, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 101.59, "10th_percentile": 101.59, "90th_percentile": 169.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 199.37, "10th_percentile": 97.54, "90th_percentile": 299.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 236.38, "10th_percentile": 236.38, "90th_percentile": 236.38, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 73.62, "10th_percentile": 49.08, "90th_percentile": 98.16, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 121.35, "10th_percentile": 91.01, "90th_percentile": 182.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 240.14, "10th_percentile": 240.14, "90th_percentile": 240.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 91.84, "10th_percentile": 68.88, "90th_percentile": 144.48, "count": "1 through 10" } ] } ] }, { "description": "74150 FAC CT ABDOMEN W/O CONTRAST", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1737.75, "discounted_cash": 538.0, "minimum": 521.325, "maximum": 1576.1392, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 478.42, "10th_percentile": 478.42, "90th_percentile": 478.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 469.04, "10th_percentile": 469.04, "90th_percentile": 469.04, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 469.04, "10th_percentile": 469.04, "90th_percentile": 497.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 469.04, "10th_percentile": 469.04, "90th_percentile": 469.04, "count": "1 through 10" } ] } ] }, { "description": "Serotonin Level", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.75, "discounted_cash": 96.0, "minimum": 93.825, "maximum": 289.35, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 255.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 289.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 198.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 288.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 100.08, "10th_percentile": 100.08, "90th_percentile": 100.08, "count": "1 through 10" } ] } ] }, { "description": "HSV Type 1 Glycoprotein IgG", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 63.0, "minimum": 60.975, "maximum": 184.3477, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 203.25, "10th_percentile": 203.25, "90th_percentile": 203.25, "count": "1 through 10" } ] } ] }, { "description": "XR Scapula Left", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.5, "discounted_cash": 103.0, "minimum": 77.3, "maximum": 301.5775, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 332.5, "10th_percentile": 332.5, "90th_percentile": 332.5, "count": "1 through 10" } ] } ] }, { "description": "OTA MMT, Total Body With Hand Units", "code_information": [ { "code": "95834", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.75, "discounted_cash": 56.0, "minimum": 54.225, "maximum": 163.9402, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "566", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 8833.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8833.48 } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 18559.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18559.39 } ] } ] }, { "description": "Bill Platelet Antibody Screen", "code_information": [ { "code": "86022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 856.0, "discounted_cash": 265.0, "minimum": 117.51, "maximum": 776.392, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.24 } ] } ] }, { "description": "Hepatitis Be Antibody", "code_information": [ { "code": "86707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.25, "discounted_cash": 35.0, "minimum": 34.575, "maximum": 108.05, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.85 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 36.88, "count": "1 through 10" } ] } ] }, { "description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC", "code_information": [ { "code": "863", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 6629.0594, "maximum": 11764.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11764.22 } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC", "code_information": [ { "code": "435", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 21652.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21652.82 } ] } ] }, { "description": "XR Cervical Port Lat Min 4 Views", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.25, "discounted_cash": 195.0, "minimum": 145.9, "maximum": 571.6368, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 395.34, "10th_percentile": 395.34, "90th_percentile": 395.34, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 267.53, "10th_percentile": 267.53, "90th_percentile": 283.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 197.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 205.71, "10th_percentile": 194.04, "90th_percentile": 205.71, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 197.56 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 378.1, "10th_percentile": 378.1, "90th_percentile": 378.1, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 494.94, "10th_percentile": 475.84, "90th_percentile": 494.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 346.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 201.68, "10th_percentile": 201.68, "90th_percentile": 241.74, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 460.14, "10th_percentile": 460.14, "90th_percentile": 460.14, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 594.5, "10th_percentile": 594.5, "90th_percentile": 630.25, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 201.68, "10th_percentile": 190.24, "90th_percentile": 201.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 571.64, "10th_percentile": 571.64, "90th_percentile": 571.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 201.68, "10th_percentile": 190.24, "90th_percentile": 332.39, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 190.24, "10th_percentile": 190.24, "90th_percentile": 190.24, "count": "1 through 10" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CCMCC", "code_information": [ { "code": "066", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 14708.8507, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8068.38 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "166", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16313.0, "minimum": 16313.48, "maximum": 44063.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44063.67 } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [ { "code": "870", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27260.0, "minimum": 27260.68, "maximum": 81483.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81483.07 } ] } ] }, { "description": "75743 FAC ARTERY X-RAYS LUNGS", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7671.25, "discounted_cash": 2378.0, "minimum": 609.1588, "maximum": 6957.8237, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 875.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1185.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1185.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.16 } ] } ] }, { "description": "NM Salivary Gland Scan", "code_information": [ { "code": "78230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.75, "discounted_cash": 234.0, "minimum": 227.325, "maximum": 757.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 532.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 720.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 720.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 757.75 } ] } ] }, { "description": "Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.25, "discounted_cash": 32.0, "minimum": 31.275, "maximum": 104.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 33.36, "10th_percentile": 33.36, "90th_percentile": 33.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 33.36, "10th_percentile": 33.36, "90th_percentile": 33.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 33.36, "10th_percentile": 33.36, "90th_percentile": 33.36, "count": "1 through 10" } ] } ] }, { "description": "Magnesium, Blood Level", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.0, "discounted_cash": 26.0, "minimum": 25.8, "maximum": 78.002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.7, "10th_percentile": 38.7, "90th_percentile": 38.7, "count": "70" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.07, "10th_percentile": 28.07, "90th_percentile": 28.07, "count": "54" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.85 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 54.7, "10th_percentile": 35.26, "90th_percentile": 54.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 67.54, "10th_percentile": 67.54, "90th_percentile": 68.83, "count": "20" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.0, "10th_percentile": 27.52, "90th_percentile": 86.0, "count": "25" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 57.19, "10th_percentile": 16.62, "90th_percentile": 114.38, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 86.0, "10th_percentile": 86.0, "90th_percentile": 86.0, "count": "221" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "301" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 78.0, "10th_percentile": 27.52, "90th_percentile": 78.78, "count": "61" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "159" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "65" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "1 through 10" } ] } ] }, { "description": "88307 AP Bill Surgical Pathology Level V Complexity", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.25, "discounted_cash": 191.0, "minimum": 185.775, "maximum": 619.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 420.9, "10th_percentile": 420.9, "90th_percentile": 420.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 619.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 619.25, "10th_percentile": 619.25, "90th_percentile": 619.25, "count": "1 through 10" } ] } ] }, { "description": "REM FB CORNEA SLIT FAC", "code_information": [ { "code": "65222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434.75, "discounted_cash": 134.0, "minimum": 130.425, "maximum": 394.3182, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 434.75, "10th_percentile": 434.75, "90th_percentile": 434.75, "count": "1 through 10" } ] } ] }, { "description": "Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.75, "discounted_cash": 30.0, "minimum": 29.625, "maximum": 89.5662, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.05 } ] } ] }, { "description": "OT Work Hardening-Each Addl Hour Units", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.0, "discounted_cash": 75.0, "minimum": 73.5, "maximum": 222.215, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Legionella Ab", "code_information": [ { "code": "86713", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.5, "discounted_cash": 76.0, "minimum": 73.65, "maximum": 222.6685, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 126.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.62 } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC", "code_information": [ { "code": "626", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 17676.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17676.4 } ] } ] }, { "description": "Tacrolimus (FK506) (Prograf)", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.25, "discounted_cash": 75.0, "minimum": 46.62, "maximum": 220.6277, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.4, "10th_percentile": 74.91, "90th_percentile": 79.4, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 77.84, "count": "54" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 220.63, "10th_percentile": 220.63, "90th_percentile": 220.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 77.84, "count": "11" } ] } ] }, { "description": "Phenobarbital Level", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.0, "discounted_cash": 61.0, "minimum": 59.1, "maximum": 178.679, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.62 } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC", "code_information": [ { "code": "011", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24470.0, "minimum": 24470.21, "maximum": 64298.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64298.28 } ] } ] }, { "description": "XR Neck Soft Tissue 1 View", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.75, "discounted_cash": 106.0, "minimum": 72.93, "maximum": 310.8743, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 256.56, "10th_percentile": 256.56, "90th_percentile": 256.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 267.6, "10th_percentile": 267.6, "90th_percentile": 273.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 334.5, "10th_percentile": 171.38, "90th_percentile": 342.75, "count": "1 through 10" } ] } ] }, { "description": "MRI Thoracic Spine w Contrast", "code_information": [ { "code": "72147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2050.5, "discounted_cash": 635.0, "minimum": 615.15, "maximum": 2050.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2050.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2050.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1669.5 } ] } ] }, { "description": "Manganese Level, Serum", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.25, "discounted_cash": 81.0, "minimum": 79.275, "maximum": 248.4206, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 229.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 157.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 84.56, "10th_percentile": 84.56, "90th_percentile": 84.56, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 22287.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22287.07 } ] } ] }, { "description": "Magnesium Sulfate Inj 50%", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323006401", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 57.91, "10th_percentile": 57.91, "90th_percentile": 173.72, "count": "1 through 10" } ] } ] }, { "description": "SIM REP TRK 2.6-7.5C FAC", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 123.0, "minimum": 119.4, "maximum": 360.986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 305.27, "10th_percentile": 293.35, "90th_percentile": 305.27, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.55, "10th_percentile": 170.55, "90th_percentile": 305.27, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.71, "10th_percentile": 123.71, "90th_percentile": 129.91, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 318.4, "10th_percentile": 318.4, "90th_percentile": 325.97, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 379.0, "10th_percentile": 379.0, "90th_percentile": 398.0, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.36, "10th_percentile": 121.28, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 317.52, "10th_percentile": 127.36, "90th_percentile": 360.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.36, "10th_percentile": 127.36, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.36, "10th_percentile": 121.28, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.36, "10th_percentile": 127.36, "90th_percentile": 127.36, "count": "1 through 10" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITHOUT CCMCC", "code_information": [ { "code": "572", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 13513.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13513.71 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [ { "code": "177", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 9444.64, "maximum": 20694.2236, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9444.64, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11457.9, "10th_percentile": 4583.16, "90th_percentile": 23447.05, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 9444.64, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8471.46, "10th_percentile": 8471.46, "90th_percentile": 8471.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18422.64 } ] } ] }, { "description": "REM FB CORNEA WO SLIT FAC", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 367.0, "discounted_cash": 113.0, "minimum": 110.1, "maximum": 332.869, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 367.0, "10th_percentile": 367.0, "90th_percentile": 367.0, "count": "1 through 10" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20606.0, "minimum": 20606.5, "maximum": 64720.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64720.32 } ] } ] }, { "description": "US LT Ext Msk COMP 78803", "code_information": [ { "code": "76883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4697.75, "discounted_cash": 1456.0, "minimum": 121.2307, "maximum": 4260.8593, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.23 } ] } ] }, { "description": "Collection Capillary Blood Specimen", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.25, "discounted_cash": 5.0, "minimum": 5.775, "maximum": 17.4597, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "58" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 5.6, "10th_percentile": 5.6, "90th_percentile": 5.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 77.85, "10th_percentile": 77.85, "90th_percentile": 77.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 114.25, "10th_percentile": 5.6, "90th_percentile": 150.25, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 5.6, "10th_percentile": 5.6, "90th_percentile": 5.6, "count": "1 through 10" } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITHOUT CCMCC", "code_information": [ { "code": "387", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 8031.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8031.83 } ] } ] }, { "description": "Amino Acids, Urine", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1388.0, "discounted_cash": 430.0, "minimum": 68.4, "maximum": 1258.916, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.26 } ] } ] }, { "description": "OSTEOMYELITIS WITHOUT CCMCC", "code_information": [ { "code": "541", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 9282.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9282.64 } ] } ] }, { "description": "99291 - Critical Care - Lynx Visit Level", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4193.0, "discounted_cash": 1299.0, "minimum": 1257.9, "maximum": 3803.051, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 3216.03, "10th_percentile": 2822.0, "90th_percentile": 3216.03, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1640.7, "10th_percentile": 1640.7, "90th_percentile": 1640.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 2777.44, "10th_percentile": 2777.44, "90th_percentile": 2777.45, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1368.6, "10th_percentile": 1368.6, "90th_percentile": 1368.6, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 2859.64, "10th_percentile": 2859.64, "90th_percentile": 2859.64, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 3345.18, "10th_percentile": 3345.18, "90th_percentile": 4868.38, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 3309.13, "10th_percentile": 332.88, "90th_percentile": 4193.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 4193.0, "10th_percentile": 3646.0, "90th_percentile": 4193.0, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1341.76, "10th_percentile": 1166.72, "90th_percentile": 1341.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1341.76, "10th_percentile": 1166.72, "90th_percentile": 3803.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1166.72, "10th_percentile": 1166.72, "90th_percentile": 1341.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1341.76, "10th_percentile": 1341.76, "90th_percentile": 1341.76, "count": "1 through 10" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 9444.64, "maximum": 42654.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42654.89 } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "271", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 41925.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41925.15 } ] } ] }, { "description": "SLP Evaluation of Speech Fluency Units", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 428.25, "discounted_cash": 132.0, "minimum": 95.0, "maximum": 388.4228, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "346", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 13984.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13984.09 } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 17203.7511, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16755.68 } ] } ] }, { "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": 3005.0, "minimum": 3005.11, "maximum": 14244.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14244.62 } ] } ] }, { "description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [ { "code": "556", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 17203.6978, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5795.58, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17052.4, "10th_percentile": 17052.4, "90th_percentile": 17052.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 17203.7, "standard_charge_algorithm": "90.7% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21315.5, "10th_percentile": 21315.5, "90th_percentile": 21315.5, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9791.93 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "515", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14381.0, "minimum": 14381.62, "maximum": 37570.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37570.3 } ] } ] }, { "description": "Beta 2 Microglobulin", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.75, "discounted_cash": 66.0, "minimum": 64.125, "maximum": 193.8713, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 133.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 103.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 68.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 68.4, "count": "1 through 10" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "395", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 7651.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7651.05 } ] } ] }, { "description": "Mumps Antibody IgG", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.75, "discounted_cash": 25.0, "minimum": 24.225, "maximum": 80.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.89, "10th_percentile": 24.89, "90th_percentile": 26.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 48.5, "10th_percentile": 48.5, "90th_percentile": 51.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 76.25, "10th_percentile": 76.25, "90th_percentile": 76.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.4, "10th_percentile": 24.4, "90th_percentile": 25.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 24.4, "10th_percentile": 24.4, "90th_percentile": 24.4, "count": "1 through 10" } ] } ] }, { "description": "L/S Ratio Amniotic Fluid", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.5, "discounted_cash": 78.0, "minimum": 76.05, "maximum": 229.9245, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 181.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.98 } ] } ] }, { "description": "Toxoplasmosis Ab, IgM", "code_information": [ { "code": "86778", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.5, "discounted_cash": 42.0, "minimum": 40.95, "maximum": 134.54, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.32 } ] } ] }, { "description": "Semen Analysis, Complete", "code_information": [ { "code": "89322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.25, "discounted_cash": 95.0, "minimum": 92.175, "maximum": 278.6757, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 99.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.48 } ] } ] }, { "description": "Vitamin B1 (Thiamine), Whole Blood", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281.5, "discounted_cash": 87.0, "minimum": 84.45, "maximum": 255.3205, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 198.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 91.88, "10th_percentile": 91.88, "90th_percentile": 91.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.87 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 225.31, "10th_percentile": 225.31, "90th_percentile": 225.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 169.06, "10th_percentile": 169.06, "90th_percentile": 169.06, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 281.5, "10th_percentile": 281.5, "90th_percentile": 281.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 90.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 90.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 90.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 90.08, "count": "1 through 10" } ] } ] }, { "description": "CT Simulation Simple", "code_information": [ { "code": "77280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1031.25, "discounted_cash": 319.0, "minimum": 309.375, "maximum": 935.3438, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 602.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 815.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.8 } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 15936.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15936.34 } ] } ] }, { "description": "Chlamydia trachomatis NAT", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.25, "discounted_cash": 27.0, "minimum": 26.775, "maximum": 89.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 56.03, "10th_percentile": 56.03, "90th_percentile": 68.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 40.16, "10th_percentile": 37.91, "90th_percentile": 40.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 89.25, "10th_percentile": 89.25, "90th_percentile": 89.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 56.76, "10th_percentile": 53.58, "90th_percentile": 71.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 67.43, "10th_percentile": 67.43, "90th_percentile": 70.09, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 56.03, "10th_percentile": 56.03, "90th_percentile": 68.45, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 89.25, "10th_percentile": 84.25, "90th_percentile": 89.25, "count": "113" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.56, "10th_percentile": 26.96, "90th_percentile": 28.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 77.17, "10th_percentile": 67.21, "90th_percentile": 80.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 26.96, "count": "1 through 10" } ] } ] }, { "description": "SPINAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "030", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 25879.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25879.17 } ] } ] }, { "description": "XR Knee Left 2 Views", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.5, "discounted_cash": 54.0, "minimum": 52.65, "maximum": 175.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 128.1, "10th_percentile": 128.1, "90th_percentile": 128.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.48, "10th_percentile": 74.48, "90th_percentile": 78.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.28, "10th_percentile": 57.28, "90th_percentile": 57.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 52.96, "10th_percentile": 52.96, "90th_percentile": 52.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 175.5, "10th_percentile": 165.5, "90th_percentile": 175.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.16, "10th_percentile": 56.16, "90th_percentile": 56.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.16, "10th_percentile": 52.96, "90th_percentile": 190.65, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 52.96, "10th_percentile": 52.96, "90th_percentile": 56.16, "count": "1 through 10" } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC", "code_information": [ { "code": "097", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18674.0, "minimum": 18674.64, "maximum": 42579.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42579.44 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [ { "code": "824", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10517.0, "minimum": 10517.9, "maximum": 26709.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26709.11 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 8160.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8160.33 } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17601.0, "minimum": 17601.38, "maximum": 64399.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64399.66 } ] } ] }, { "description": "88300 AP Bill Surgical Pathology Level I Complexity", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 38.0, "minimum": 37.5, "maximum": 125.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 96.75, "10th_percentile": 96.75, "90th_percentile": 96.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 67.98, "10th_percentile": 66.24, "90th_percentile": 82.8, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 98.16, "10th_percentile": 98.16, "90th_percentile": 98.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "1 through 10" } ] } ] }, { "description": "HIV-1 RNA, QL TMA", "code_information": [ { "code": "87535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 776.0, "discounted_cash": 240.0, "minimum": 166.63, "maximum": 703.832, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09 } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "463", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22753.0, "minimum": 22753.01, "maximum": 67191.29, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67191.29 } ] } ] }, { "description": "Mycoplasma genitalium, rRNA, TMA", "code_information": [ { "code": "87563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 475.25, "discounted_cash": 147.0, "minimum": 142.575, "maximum": 431.0518, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09 } ] } ] }, { "description": "CT Angio Abd Pelvis", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2512.0, "discounted_cash": 778.0, "minimum": 650.0, "maximum": 2501.78, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 803.84, "10th_percentile": 803.84, "90th_percentile": 803.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1066.39, "10th_percentile": 1066.39, "90th_percentile": 1130.4, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2501.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 773.49, "10th_percentile": 773.49, "90th_percentile": 819.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2501.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2436.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2512.0, "10th_percentile": 2369.75, "90th_percentile": 2512.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 803.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 758.32, "10th_percentile": 758.32, "90th_percentile": 758.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 803.84, "10th_percentile": 803.84, "90th_percentile": 803.84, "count": "1 through 10" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "739", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 42237.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42237.56 } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "754", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 21711.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21711.76 } ] } ] }, { "description": "Cytogenomic SNP Microarray", "code_information": [ { "code": "81229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2204.0, "discounted_cash": 683.0, "minimum": 74.13, "maximum": 2204.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2204.0 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "909", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 15475.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15475.39 } ] } ] }, { "description": "Albumin, CSF", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.5, "discounted_cash": 10.0, "minimum": 10.35, "maximum": 34.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.76, "10th_percentile": 9.76, "90th_percentile": 9.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.76, "10th_percentile": 9.76, "90th_percentile": 9.76, "count": "1 through 10" } ] } ] }, { "description": "Vitamin E (alpha-Tocophenol)", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.75, "discounted_cash": 43.0, "minimum": 41.625, "maximum": 132.43, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 90.7 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 111.06, "10th_percentile": 111.06, "90th_percentile": 111.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 138.75, "10th_percentile": 138.75, "90th_percentile": 138.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.4, "10th_percentile": 44.4, "90th_percentile": 44.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.4, "10th_percentile": 44.4, "90th_percentile": 44.4, "count": "1 through 10" } ] } ] }, { "description": "Metoclopramide HCl Inj 5 MG/ML (Base Equivalent)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "23155024031", "type": "NDC" }, { "code": "J2765", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 17.97, "10th_percentile": 17.97, "90th_percentile": 17.97, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 23.32, "10th_percentile": 23.32, "90th_percentile": 23.32, "count": "1 through 10" } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [ { "code": "557", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 7116.3013, "maximum": 17529.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17529.03 } ] } ] }, { "description": "Zinc Level", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.0, "discounted_cash": 28.0, "minimum": 27.3, "maximum": 91.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.86 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 57.88, "10th_percentile": 57.88, "90th_percentile": 57.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 91.0, "10th_percentile": 91.0, "90th_percentile": 290.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 29.12, "10th_percentile": 29.12, "90th_percentile": 29.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 29.12, "10th_percentile": 29.12, "90th_percentile": 29.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 29.12, "10th_percentile": 29.12, "90th_percentile": 29.12, "count": "1 through 10" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH MCC", "code_information": [ { "code": "570", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16742.0, "minimum": 16742.78, "maximum": 34672.57, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34672.57 } ] } ] }, { "description": "XR Cystogram 3 Views", "code_information": [ { "code": "74430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653.5, "discounted_cash": 202.0, "minimum": 196.05, "maximum": 592.7245, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 246.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 333.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 333.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.79 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC", "code_information": [ { "code": "656", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10732.0, "minimum": 10732.55, "maximum": 37533.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37533.75 } ] } ] }, { "description": "NM Thyroid Mets Image Limited", "code_information": [ { "code": "78015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1218.75, "discounted_cash": 377.0, "minimum": 365.625, "maximum": 1218.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 675.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 914.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 914.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1218.75 } ] } ] }, { "description": "Covid-19 Ag", "code_information": [ { "code": "87811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 15.0, "minimum": 15.0, "maximum": 50.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.0 } ] } ] }, { "description": "MRI Cardiac wo 75557", "code_information": [ { "code": "75557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 782.5, "discounted_cash": 242.0, "minimum": 234.75, "maximum": 782.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 782.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 782.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 782.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 782.5 } ] } ] }, { "description": "Mononucleosis Screen", "code_information": [ { "code": "86308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.75, "discounted_cash": 29.0, "minimum": 28.425, "maximum": 85.9382, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 59.52, "10th_percentile": 59.52, "90th_percentile": 59.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 77.6, "10th_percentile": 60.26, "90th_percentile": 113.84, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 74.41, "10th_percentile": 74.41, "90th_percentile": 74.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 89.5, "10th_percentile": 17.5, "90th_percentile": 94.75, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 52.95, "10th_percentile": 52.95, "90th_percentile": 52.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.64, "10th_percentile": 28.64, "90th_percentile": 28.64, "count": "1 through 10" } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CCMCC", "code_information": [ { "code": "749", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 30269.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30269.39 } ] } ] }, { "description": "Lactoferrin, Quant, Stool", "code_information": [ { "code": "83631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.5, "discounted_cash": 152.0, "minimum": 125.57, "maximum": 444.8835, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 162.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 183.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 125.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 182.98 } ] } ] }, { "description": "NM GI Bleed Localization", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 803.5, "discounted_cash": 249.0, "minimum": 241.05, "maximum": 803.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 803.5 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "144", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 20429.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20429.12 } ] } ] }, { "description": "XR Lower Extremity Infant 2 Views Left", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.25, "discounted_cash": 147.0, "minimum": 78.79, "maximum": 432.8657, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.05 } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [ { "code": "964", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 18067.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18067.79 } ] } ] }, { "description": "Entomoeba histolytica Antigen Stool, EIA", "code_information": [ { "code": "87337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.5, "discounted_cash": 49.0, "minimum": 47.55, "maximum": 143.7595, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.67 } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [ { "code": "326", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19103.0, "minimum": 19103.94, "maximum": 58796.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58796.36 } ] } ] }, { "description": "Work Condition Initial 2 Hours OT", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.5, "discounted_cash": 140.0, "minimum": 95.0, "maximum": 410.4175, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Trypsin Level", "code_information": [ { "code": "84490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.5, "discounted_cash": 17.0, "minimum": 16.65, "maximum": 55.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.5 } ] } ] }, { "description": "NM Meckels Abdomen Scan", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 872.5, "discounted_cash": 270.0, "minimum": 261.75, "maximum": 872.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 872.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 872.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 872.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 872.5 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "356", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16313.0, "minimum": 16313.48, "maximum": 51786.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51786.63 } ] } ] }, { "description": "88334 AP Bill Cytologic Exam Additional Site", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.5, "discounted_cash": 30.0, "minimum": 29.85, "maximum": 99.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.5 } ] } ] }, { "description": "REM FB SUBQ SIMPLE FAC", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.25, "discounted_cash": 93.0, "minimum": 90.075, "maximum": 272.3268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 221.36, "10th_percentile": 221.36, "90th_percentile": 221.36, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 300.25, "10th_percentile": 286.0, "90th_percentile": 300.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 272.33, "10th_percentile": 272.33, "90th_percentile": 272.33, "count": "1 through 10" } ] } ] }, { "description": "NM First Pass Single", "code_information": [ { "code": "78481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.5, "discounted_cash": 104.0, "minimum": 100.65, "maximum": 335.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.5 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13308.0, "minimum": 13308.36, "maximum": 70811.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70811.69 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [ { "code": "196", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 5617.9532, "maximum": 22248.16, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22248.16 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 12615.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12615.39 } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC", "code_information": [ { "code": "354", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 19833.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19833.78 } ] } ] }, { "description": "Myelin Basic Protein", "code_information": [ { "code": "83873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.5, "discounted_cash": 71.0, "minimum": 68.85, "maximum": 208.1565, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.33 } ] } ] }, { "description": "US Fetal Biophys Prof wo Non-Stress", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.0, "discounted_cash": 193.0, "minimum": 187.2, "maximum": 565.968, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 223.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 302.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 302.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.18 } ] } ] }, { "description": "Hepatitis B Surface Ag Confirmation", "code_information": [ { "code": "87341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.25, "discounted_cash": 43.0, "minimum": 42.075, "maximum": 127.2067, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.29 } ] } ] }, { "description": "Amnisure", "code_information": [ { "code": "84112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.25, "discounted_cash": 60.0, "minimum": 58.275, "maximum": 194.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.25 } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 26599.9064, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7936.34 } ] } ] }, { "description": "NM Thyroid Therapy Hyperthyroid", "code_information": [ { "code": "79005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.5, "discounted_cash": 148.0, "minimum": 143.25, "maximum": 434.3133, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 343.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 434.31 } ] } ] }, { "description": "XM AHG Interp (Automated)", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 63.0, "minimum": 61.2, "maximum": 204.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 183.6, "10th_percentile": 183.6, "90th_percentile": 183.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 130.56, "10th_percentile": 130.56, "90th_percentile": 130.56, "count": "1 through 10" } ] } ] }, { "description": "75825 FAC VEIN XRAY TRUNK", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6611.0, "discounted_cash": 2049.0, "minimum": 521.7361, "maximum": 5996.177, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 831.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1125.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1125.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 521.74 } ] } ] }, { "description": "Rabies Immune Globulin (Human) Inj 1500 Unt/5ML (300 Unt/ML)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "13533031803", "type": "NDC" }, { "code": "90375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 8165.79, "10th_percentile": 8165.79, "90th_percentile": 8165.79, "count": "1 through 10" } ] } ] }, { "description": "Lacosamide (Vimpat) Level", "code_information": [ { "code": "80339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 699.5, "discounted_cash": 216.0, "minimum": 46.608, "maximum": 634.4465, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.61 } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "418", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 19942.24, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19942.24 } ] } ] }, { "description": "Monkeypox Virus DNA, QL PCR", "code_information": [ { "code": "87593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 42.0, "minimum": 40.8, "maximum": 136.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.0 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9873.0, "minimum": 9873.95, "maximum": 26783.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26783.38 } ] } ] }, { "description": "$ AP 88362 Nerve Tesing Prep", "code_information": [ { "code": "88362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 772.0, "discounted_cash": 239.0, "minimum": 231.6, "maximum": 772.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 772.0 } ] } ] }, { "description": "MRI Angio Head wo Contrast", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1925.5, "discounted_cash": 596.0, "minimum": 577.65, "maximum": 1906.22, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 628.48, "10th_percentile": 628.48, "90th_percentile": 628.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1401.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" } ] } ] }, { "description": "EP Interp", "code_information": [ { "code": "84166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.5, "discounted_cash": 68.0, "minimum": 66.15, "maximum": 199.9935, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.2 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18459.0, "minimum": 18459.99, "maximum": 40726.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40726.21 } ] } ] }, { "description": "Calcitonin Level", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 754.75, "discounted_cash": 233.0, "minimum": 171.32, "maximum": 684.5583, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 221.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 250.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 171.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 249.73 } ] } ] }, { "description": "Fibrinogen Level", "code_information": [ { "code": "85384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.75, "discounted_cash": 40.0, "minimum": 39.525, "maximum": 119.4972, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 54.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 131.75, "10th_percentile": 124.25, "90th_percentile": 131.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 42.16, "10th_percentile": 42.16, "90th_percentile": 42.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.16, "10th_percentile": 42.16, "90th_percentile": 42.16, "count": "1 through 10" } ] } ] }, { "description": "VL Duplex Scan Abd Viscera Limited - Vascular US Charges", "code_information": [ { "code": "93976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1626.25, "discounted_cash": 504.0, "minimum": 487.875, "maximum": 1475.0087, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 493.56, "10th_percentile": 493.56, "90th_percentile": 493.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 273.15, "10th_percentile": 273.15, "90th_percentile": 273.15, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 426.25, "10th_percentile": 340.99, "90th_percentile": 426.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 198.12, "10th_percentile": 198.12, "90th_percentile": 198.12, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 514.8, "10th_percentile": 497.13, "90th_percentile": 514.8, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 643.5, "10th_percentile": 643.5, "90th_percentile": 643.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 205.92, "10th_percentile": 194.24, "90th_percentile": 205.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 556.01, "10th_percentile": 556.01, "90th_percentile": 556.01, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 205.92, "10th_percentile": 205.92, "90th_percentile": 205.92, "count": "1 through 10" } ] } ] }, { "description": "Fragile X (FMR1) Diagnostic", "code_information": [ { "code": "81244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1389.5, "discounted_cash": 430.0, "minimum": 123.56, "maximum": 1260.2765, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.45 } ] } ] }, { "description": "OT Eval High Complex", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.5, "discounted_cash": 155.0, "minimum": 95.0, "maximum": 454.8605, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" } ] } ] }, { "description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [ { "code": "791", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28548.0, "minimum": 28548.58, "maximum": 47851.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47851.47 } ] } ] }, { "description": "Iron Binding Capacity Total", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.25, "discounted_cash": 33.0, "minimum": 32.175, "maximum": 97.2758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 71.32, "10th_percentile": 71.32, "90th_percentile": 71.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.26, "10th_percentile": 48.26, "90th_percentile": 48.26, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.01, "10th_percentile": 35.01, "90th_percentile": 35.01, "count": "37" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.95 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 68.21, "10th_percentile": 68.21, "90th_percentile": 68.21, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 84.22, "10th_percentile": 84.22, "90th_percentile": 85.84, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "15" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 71.32, "10th_percentile": 20.73, "90th_percentile": 82.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "116" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "147" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 97.28, "10th_percentile": 34.32, "90th_percentile": 98.24, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "84" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "13" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "13" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "091", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 9444.64, "maximum": 22091.8353, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20703.81 } ] } ] }, { "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": 7083.0, "minimum": 6413.1951, "maximum": 14923.67, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7083.48, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9856.48, "10th_percentile": 9856.48, "90th_percentile": 9856.48, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14923.67 } ] } ] }, { "description": "Cyclic Citrullinated Peptide Ab, IgG", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 55.0, "minimum": 54.0, "maximum": 163.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 131.39, "10th_percentile": 131.39, "90th_percentile": 131.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.75, "10th_percentile": 55.41, "90th_percentile": 58.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 180.0, "10th_percentile": 169.75, "90th_percentile": 180.0, "count": "17" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.6, "10th_percentile": 57.6, "90th_percentile": 57.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.32, "10th_percentile": 54.32, "90th_percentile": 54.32, "count": "1 through 10" } ] } ] }, { "description": "HDL Cholesterol", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.75, "discounted_cash": 43.0, "minimum": 42.525, "maximum": 128.5673, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.34 } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 23157.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23157.09 } ] } ] }, { "description": "BhCG Qual", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 29.0, "minimum": 28.35, "maximum": 85.7115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 62.84, "10th_percentile": 62.84, "90th_percentile": 62.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 75.6, "10th_percentile": 75.6, "90th_percentile": 75.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 74.21, "10th_percentile": 74.21, "90th_percentile": 74.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.1 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 72.48, "10th_percentile": 72.48, "90th_percentile": 72.48, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "28" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 75.39, "10th_percentile": 75.39, "90th_percentile": 85.71, "count": "1 through 10" } ] } ] }, { "description": "Immun Each Addl Vaccine OBS", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.25, "discounted_cash": 6.0, "minimum": 6.075, "maximum": 18.3667, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 15.53, "10th_percentile": 15.53, "90th_percentile": 15.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 6.61, "10th_percentile": 6.61, "90th_percentile": 6.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 40.5, "count": "99" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 6.48, "10th_percentile": 6.48, "90th_percentile": 6.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 18.37, "10th_percentile": 18.37, "90th_percentile": 18.37, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 6.48, "10th_percentile": 6.48, "90th_percentile": 6.48, "count": "1 through 10" } ] } ] }, { "description": "NM Urinary Bladder Residual Study", "code_information": [ { "code": "78730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.25, "discounted_cash": 52.0, "minimum": 51.075, "maximum": 170.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 170.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.25 } ] } ] }, { "description": "Factor XII, Activity", "code_information": [ { "code": "85280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.25, "discounted_cash": 89.0, "minimum": 86.475, "maximum": 261.4427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.37 } ] } ] }, { "description": "Sendout BRAF Mutation Detection by Pyrosequencing", "code_information": [ { "code": "81210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1052.0, "discounted_cash": 326.0, "minimum": 315.6, "maximum": 1052.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 451.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 510.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 349.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1052.0 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 14676.8277, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 7083.48, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9192.0, "10th_percentile": 9192.0, "90th_percentile": 9192.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13058.65 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15454.0, "minimum": 15454.87, "maximum": 16688.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16688.48 } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "136", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2790.0, "minimum": 2790.46, "maximum": 11969.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11969.35 } ] } ] }, { "description": "Throat, Group A Strep Screen", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.25, "discounted_cash": 38.0, "minimum": 37.11, "maximum": 112.6947, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 77.97, "10th_percentile": 77.97, "90th_percentile": 77.97, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 55.91, "10th_percentile": 55.91, "90th_percentile": 55.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.27, "10th_percentile": 38.27, "90th_percentile": 40.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.11 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 79.02, "10th_percentile": 74.57, "90th_percentile": 101.76, "count": "19" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 97.57, "10th_percentile": 93.85, "90th_percentile": 97.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.8 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 95.3, "10th_percentile": 95.3, "90th_percentile": 95.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 117.25, "10th_percentile": 117.25, "90th_percentile": 124.25, "count": "146" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.52, "10th_percentile": 37.52, "90th_percentile": 39.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 69.44, "10th_percentile": 69.44, "90th_percentile": 107.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.52, "10th_percentile": 37.52, "90th_percentile": 140.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.76, "10th_percentile": 37.52, "90th_percentile": 39.76, "count": "1 through 10" } ] } ] }, { "description": "CT Cervical Spine w Contrast", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2606.0, "discounted_cash": 807.0, "minimum": 650.0, "maximum": 2363.642, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1528.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1528.9 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 981.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2458.5, "10th_percentile": 2458.5, "90th_percentile": 2458.5, "count": "1 through 10" } ] } ] }, { "description": "Bill Prenatal Panel", "code_information": [ { "code": "80055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.5, "discounted_cash": 81.0, "minimum": 79.05, "maximum": 263.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 263.5 } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "654", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 33000.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33000.89 } ] } ] }, { "description": "Rubeola (Measles) Ab, IgG", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 13.0, "minimum": 13.5, "maximum": 45.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 59.6, "10th_percentile": 59.6, "90th_percentile": 59.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.87, "10th_percentile": 13.87, "90th_percentile": 14.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 27.03, "10th_percentile": 27.03, "90th_percentile": 28.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 42.5, "10th_percentile": 42.5, "90th_percentile": 45.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.6, "10th_percentile": 13.6, "90th_percentile": 14.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 13.6, "10th_percentile": 13.6, "90th_percentile": 13.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.4, "10th_percentile": 14.4, "90th_percentile": 14.4, "count": "1 through 10" } ] } ] }, { "description": "MRI Pelvis w+wo Contrast", "code_information": [ { "code": "72197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3269.0, "discounted_cash": 1013.0, "minimum": 900.0, "maximum": 2964.983, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2951.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2951.23 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2061.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 3269.0, "10th_percentile": 3269.0, "90th_percentile": 3269.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1046.08, "10th_percentile": 1046.08, "90th_percentile": 1046.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1046.08, "10th_percentile": 1046.08, "90th_percentile": 1046.08, "count": "1 through 10" } ] } ] }, { "description": "XR Hysterosalpingogram in the OR", "code_information": [ { "code": "74740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992.25, "discounted_cash": 307.0, "minimum": 233.43, "maximum": 899.9707, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 316.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 316.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.17 } ] } ] }, { "description": "DHEA Sulfate", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.75, "discounted_cash": 93.0, "minimum": 90.225, "maximum": 272.7803, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 183.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 207.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 142.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 300.75, "10th_percentile": 300.75, "90th_percentile": 300.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 96.24, "10th_percentile": 96.24, "90th_percentile": 96.24, "count": "1 through 10" } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "301", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 8484.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8484.53 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "817", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 26897.74, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26897.74 } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "508", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 17853.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17853.23 } ] } ] }, { "description": "Lyme DNA, PCR", "code_information": [ { "code": "87801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.5, "discounted_cash": 87.0, "minimum": 85.05, "maximum": 283.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 177.89, "10th_percentile": 177.89, "90th_percentile": 177.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.58, "10th_percentile": 127.58, "90th_percentile": 127.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 283.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 283.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 92.53, "10th_percentile": 87.31, "90th_percentile": 92.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 283.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 180.31, "10th_percentile": 170.13, "90th_percentile": 340.26, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 222.63, "10th_percentile": 222.63, "90th_percentile": 222.63, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 283.5, "10th_percentile": 267.5, "90th_percentile": 283.5, "count": "34" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.72, "10th_percentile": 85.6, "90th_percentile": 90.72, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 90.72, "10th_percentile": 85.6, "90th_percentile": 257.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.72, "10th_percentile": 90.72, "90th_percentile": 90.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.72, "10th_percentile": 85.6, "90th_percentile": 90.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.72, "10th_percentile": 90.72, "90th_percentile": 90.72, "count": "1 through 10" } ] } ] }, { "description": "ALLERGY IMMUNOTHERAPY >1", "code_information": [ { "code": "95117", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.25, "discounted_cash": 34.0, "minimum": 33.675, "maximum": 101.8107, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 15.36, "count": "1 through 10" } ] } ] }, { "description": "NM Brain Imaging Limited w Vascular Flow", "code_information": [ { "code": "78601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 434.0, "minimum": 420.525, "maximum": 1401.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 714.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 967.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 967.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1401.75 } ] } ] }, { "description": "Bill IRL Ea Selected Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27.25, "discounted_cash": 8.0, "minimum": 8.175, "maximum": 27.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.25 } ] } ] }, { "description": "Drug Abuse Panel 12, Qualitative Urine", "code_information": [ { "code": "80306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.75, "discounted_cash": 49.0, "minimum": 47.925, "maximum": 159.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.2, "10th_percentile": 49.2, "90th_percentile": 49.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.24 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 120.66, "10th_percentile": 120.66, "90th_percentile": 120.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 159.75, "10th_percentile": 150.75, "90th_percentile": 159.75, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 51.12, "10th_percentile": 51.12, "90th_percentile": 51.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.24, "10th_percentile": 48.24, "90th_percentile": 48.24, "count": "1 through 10" } ] } ] }, { "description": "Factor VIII Activity", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.5, "discounted_cash": 40.0, "minimum": 39.45, "maximum": 131.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 131.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.53 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 167.26, "10th_percentile": 167.26, "90th_percentile": 167.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 131.5, "10th_percentile": 131.5, "90th_percentile": 131.5, "count": "1 through 10" } ] } ] }, { "description": "Fetal Fibronectin", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.0, "discounted_cash": 288.0, "minimum": 279.6, "maximum": 845.324, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 531.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 601.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 412.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.4 } ] } ] }, { "description": "NM Exametazim/Ceretec", "code_information": [ { "code": "A9521", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2011.0, "minimum": 603.3, "maximum": 2011.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2011.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2011.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2011.0 } ] } ] }, { "description": "VL Duplex Scan Carotid Bilat - Vascular US Charges", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1476.5, "discounted_cash": 457.0, "minimum": 442.95, "maximum": 1339.1855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 538.76, "10th_percentile": 538.76, "90th_percentile": 538.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 793.06, "10th_percentile": 793.06, "90th_percentile": 813.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 376.99, "10th_percentile": 376.99, "90th_percentile": 390.78, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 980.55, "10th_percentile": 980.55, "90th_percentile": 980.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 955.17, "10th_percentile": 955.17, "90th_percentile": 955.17, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 926.67, "10th_percentile": 926.67, "90th_percentile": 926.67, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1197.25, "10th_percentile": 1197.25, "90th_percentile": 1197.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 383.12, "10th_percentile": 383.12, "90th_percentile": 383.12, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 383.12, "10th_percentile": 383.12, "90th_percentile": 383.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 383.12, "10th_percentile": 383.12, "90th_percentile": 383.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 383.12, "10th_percentile": 383.12, "90th_percentile": 383.12, "count": "1 through 10" } ] } ] }, { "description": "Androstenedione", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.0, "discounted_cash": 104.0, "minimum": 101.1, "maximum": 305.659, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.94 } ] } ] }, { "description": "Immunofixation IFE, Urine", "code_information": [ { "code": "86335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.75, "discounted_cash": 67.0, "minimum": 65.325, "maximum": 217.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 217.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 217.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.75 } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITH CCMCC", "code_information": [ { "code": "713", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 17723.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17723.55 } ] } ] }, { "description": "CT Core NDL BX Lng/Med Perq 32408", "code_information": [ { "code": "32408", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4568.75, "discounted_cash": 1416.0, "minimum": 650.0, "maximum": 4143.8562, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "Helicobacter pylori Ab, IgG", "code_information": [ { "code": "86677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.75, "discounted_cash": 28.0, "minimum": 27.525, "maximum": 91.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.75 } ] } ] }, { "description": "Measles-Mumps-Rubella Virus Vaccines For Inj Soln", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00006468100", "type": "NDC" }, { "code": "90707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 0.01, "10th_percentile": 0.01, "90th_percentile": 0.01, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 12901.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12901.86 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [ { "code": "689", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 7437.1024, "maximum": 13678.75, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8156.74, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 14920.85, "10th_percentile": 14920.85, "90th_percentile": 16041.06, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13678.75 } ] } ] }, { "description": "NM Lung VQ Scan", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1461.25, "discounted_cash": 452.0, "minimum": 438.375, "maximum": 1461.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1100.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1461.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1461.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1461.25 } ] } ] }, { "description": "Anaplasma phagocytophilum by RT-PCR", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 276.5, "discounted_cash": 85.0, "minimum": 82.95, "maximum": 276.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 748.46, "10th_percentile": 748.46, "90th_percentile": 748.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 536.96, "10th_percentile": 536.96, "90th_percentile": 536.96, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 155.28, "10th_percentile": 18.28, "90th_percentile": 389.48, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 758.91, "10th_percentile": 48.53, "90th_percentile": 2589.27, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 293.35, "10th_percentile": 46.53, "90th_percentile": 937.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 276.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 45.44, "10th_percentile": 45.44, "90th_percentile": 45.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 56.0, "10th_percentile": 56.0, "90th_percentile": 237.25, "count": "88" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 381.84, "10th_percentile": 18.96, "90th_percentile": 381.84, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 53.74, "10th_percentile": 18.96, "90th_percentile": 1082.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.96, "10th_percentile": 18.96, "90th_percentile": 381.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.96, "10th_percentile": 17.92, "90th_percentile": 381.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 381.84, "10th_percentile": 17.92, "90th_percentile": 381.84, "count": "1 through 10" } ] } ] }, { "description": "Hepatitis A IgM", "code_information": [ { "code": "86709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 56.0, "minimum": 54.9, "maximum": 165.981, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 183.0, "10th_percentile": 172.75, "90th_percentile": 183.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 55.28, "10th_percentile": 55.28, "90th_percentile": 55.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.56, "10th_percentile": 55.28, "90th_percentile": 58.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.56, "10th_percentile": 58.56, "90th_percentile": 58.56, "count": "1 through 10" } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [ { "code": "917", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 4446.6189, "maximum": 18489.84, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7942.09, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6874.74, "10th_percentile": 6874.74, "90th_percentile": 6874.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18489.84 } ] } ] }, { "description": "zzssDNA Antibody, IgG", "code_information": [ { "code": "86226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.75, "discounted_cash": 47.0, "minimum": 45.825, "maximum": 138.5443, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.88 } ] } ] }, { "description": "PT Gait Training Units", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 36.0, "minimum": 35.4, "maximum": 107.026, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.1, "10th_percentile": 53.1, "90th_percentile": 53.1, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.0, "10th_percentile": 118.0, "90th_percentile": 236.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.76, "10th_percentile": 37.76, "90th_percentile": 113.28, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.76, "10th_percentile": 15.1, "90th_percentile": 113.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 75.52, "10th_percentile": 75.52, "90th_percentile": 75.52, "count": "1 through 10" } ] } ] }, { "description": "RH/BH Cystoscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069.25, "discounted_cash": 331.0, "minimum": 320.775, "maximum": 969.8098, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 644.3, "10th_percentile": 644.3, "90th_percentile": 644.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "1 through 10" } ] } ] }, { "description": "$ COVID/FLU/RSV Combo", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600.5, "discounted_cash": 186.0, "minimum": 180.15, "maximum": 600.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.5 } ] } ] }, { "description": "BK PCR", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1171.0, "discounted_cash": 363.0, "minimum": 274.02, "maximum": 1062.097, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 353.52, "10th_percentile": 353.52, "90th_percentile": 374.72, "count": "17" } ] } ] }, { "description": "96416 CHMO ADMIN IV INFUS 1-8HR - G0498 - 7336416", "code_information": [ { "code": "G0498", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1267.0, "minimum": 380.1, "maximum": 1149.169, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1267.0, "10th_percentile": 1206.75, "90th_percentile": 1267.0, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 405.44, "10th_percentile": 405.44, "90th_percentile": 405.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 405.44, "10th_percentile": 386.16, "90th_percentile": 405.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 386.16, "10th_percentile": 386.16, "90th_percentile": 386.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 405.44, "10th_percentile": 386.16, "90th_percentile": 405.44, "count": "17" } ] } ] }, { "description": "99284 - Level 4 - Lynx Visit Level", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1569.5, "discounted_cash": 486.0, "minimum": 470.85, "maximum": 1569.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 907.56, "10th_percentile": 907.56, "90th_percentile": 907.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 706.28, "10th_percentile": 614.14, "90th_percentile": 706.28, "count": "84" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 1569.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1569.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 512.28, "10th_percentile": 445.45, "90th_percentile": 512.28, "count": "92" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 1569.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 1117.73, "10th_percentile": 1117.73, "90th_percentile": 1443.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1092.35, "10th_percentile": 1092.35, "90th_percentile": 1232.53, "count": "35" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 2166.3, "10th_percentile": 1520.39, "90th_percentile": 2425.76, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 973.3, "10th_percentile": 399.84, "90th_percentile": 1569.5, "count": "88" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1056.32, "10th_percentile": 533.66, "90th_percentile": 1203.81, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1569.5, "10th_percentile": 1364.75, "90th_percentile": 1569.5, "count": "729" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 502.24, "count": "242" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1423.53, "10th_percentile": 1423.53, "90th_percentile": 1423.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 708.4, "count": "184" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 502.24, "count": "103" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 502.24, "count": "27" } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT", "code_information": [ { "code": "008", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18245.0, "minimum": 18245.34, "maximum": 66072.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66072.52 } ] } ] }, { "description": "$ Factor V Leiden", "code_information": [ { "code": "81241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.75, "discounted_cash": 99.0, "minimum": 96.225, "maximum": 320.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 292.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 320.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 226.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.75 } ] } ] }, { "description": "Bill IRL PreTx Chem or Drug Ea", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.0, "discounted_cash": 35.0, "minimum": 34.8, "maximum": 116.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 } ] } ] }, { "description": "Anti-Xa Level LMW Heparin", "code_information": [ { "code": "85520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.75, "discounted_cash": 58.0, "minimum": 56.925, "maximum": 172.1033, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 83.73 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.02 } ] } ] }, { "description": "B-hCG Qualitative Screen, Urine", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.75, "discounted_cash": 23.0, "minimum": 23.025, "maximum": 76.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 51.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.57, "10th_percentile": 12.57, "90th_percentile": 12.57, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.49 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 76.75, "10th_percentile": 76.75, "90th_percentile": 76.75, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 61.43, "10th_percentile": 60.27, "90th_percentile": 61.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.5, "10th_percentile": 38.5, "90th_percentile": 38.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 76.75, "10th_percentile": 38.5, "90th_percentile": 76.75, "count": "241" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.56, "10th_percentile": 12.32, "90th_percentile": 24.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 69.61, "10th_percentile": 69.61, "90th_percentile": 70.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.56, "10th_percentile": 24.56, "90th_percentile": 24.56, "count": "1 through 10" } ] } ] }, { "description": "HPV High Risk Screen by TMA", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.25, "discounted_cash": 54.0, "minimum": 52.875, "maximum": 176.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 135.18, "10th_percentile": 128.68, "90th_percentile": 135.18, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.81, "10th_percentile": 74.81, "90th_percentile": 74.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.26, "10th_percentile": 54.26, "90th_percentile": 54.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 155.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 105.74, "10th_percentile": 105.74, "90th_percentile": 105.74, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 133.07, "10th_percentile": 133.07, "90th_percentile": 138.41, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 99.84, "10th_percentile": 99.84, "90th_percentile": 99.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 176.25, "10th_percentile": 166.25, "90th_percentile": 176.25, "count": "50" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.2, "10th_percentile": 53.2, "90th_percentile": 53.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 152.29, "10th_percentile": 140.61, "90th_percentile": 159.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 175.29, "10th_percentile": 56.4, "90th_percentile": 591.67, "count": "1 through 10" } ] } ] }, { "description": "Rad Ther Port Film", "code_information": [ { "code": "77417", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.5, "discounted_cash": 66.0, "minimum": 64.65, "maximum": 195.4585, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 88.89 } ] } ] }, { "description": "77001 FAC FLUOROSCOPC GUIDANCE CVAD", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 584.0, "discounted_cash": 181.0, "minimum": 175.2, "maximum": 584.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 342.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 464.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 464.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 584.0 } ] } ] }, { "description": "IH PIN4 Multiplex 88344 Bill", "code_information": [ { "code": "88344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.5, "discounted_cash": 67.0, "minimum": 65.55, "maximum": 218.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.5 } ] } ] }, { "description": "Chlamydia Culture", "code_information": [ { "code": "87110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.5, "discounted_cash": 76.0, "minimum": 73.65, "maximum": 222.6685, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 161.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 182.7 } ] } ] }, { "description": "36593 DECLOT VASCLR DEV", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.0, "discounted_cash": 273.0, "minimum": 264.6, "maximum": 799.974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 650.16, "10th_percentile": 650.16, "90th_percentile": 650.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 396.9, "10th_percentile": 396.9, "90th_percentile": 396.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 584.24, "10th_percentile": 584.24, "90th_percentile": 584.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 672.34, "10th_percentile": 672.34, "90th_percentile": 692.63, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 840.0, "10th_percentile": 840.0, "90th_percentile": 840.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 268.8, "10th_percentile": 268.8, "90th_percentile": 268.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 769.44, "10th_percentile": 282.24, "90th_percentile": 799.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 268.8, "10th_percentile": 268.8, "90th_percentile": 268.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 268.8, "10th_percentile": 268.8, "90th_percentile": 268.8, "count": "1 through 10" } ] } ] }, { "description": "IV Push Each Addl Same Med", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.75, "discounted_cash": 101.0, "minimum": 98.625, "maximum": 298.1762, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 252.15, "10th_percentile": 252.15, "90th_percentile": 763.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 147.94, "10th_percentile": 147.94, "90th_percentile": 591.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 217.77, "10th_percentile": 217.77, "90th_percentile": 217.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 107.3, "10th_percentile": 107.3, "90th_percentile": 107.3, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 783.04, "10th_percentile": 395.11, "90th_percentile": 2592.45, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 328.75, "10th_percentile": 136.3, "90th_percentile": 328.75, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 254.45, "10th_percentile": 254.45, "90th_percentile": 254.45, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 328.75, "10th_percentile": 328.75, "90th_percentile": 986.25, "count": "55" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.2, "10th_percentile": 101.91, "90th_percentile": 305.74, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 298.18, "10th_percentile": 105.2, "90th_percentile": 524.55, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 315.6, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 210.4, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 210.4, "count": "1 through 10" } ] } ] }, { "description": "Arsenic Level, Blood", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.75, "discounted_cash": 12.0, "minimum": 12.525, "maximum": 41.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 41.75, "10th_percentile": 41.75, "90th_percentile": 41.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 37.87, "10th_percentile": 37.87, "90th_percentile": 37.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 13.36, "count": "1 through 10" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "833", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 6164.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6164.46 } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITH CCMCC", "code_information": [ { "code": "904", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14166.0, "minimum": 14166.97, "maximum": 43302.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43302.1 } ] } ] }, { "description": "XR Cervical Spine AP+Lat", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 466.5, "discounted_cash": 144.0, "minimum": 102.13, "maximum": 423.1155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 198.0, "10th_percentile": 198.0, "90th_percentile": 198.0, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 143.62, "10th_percentile": 143.62, "90th_percentile": 152.27, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 138.29 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 352.18, "10th_percentile": 352.18, "90th_percentile": 352.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 140.8, "10th_percentile": 140.8, "90th_percentile": 149.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 466.5, "10th_percentile": 440.0, "90th_percentile": 466.5, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 149.28, "10th_percentile": 140.8, "90th_percentile": 149.28, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 149.28, "10th_percentile": 140.8, "90th_percentile": 403.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 149.28, "10th_percentile": 140.8, "90th_percentile": 243.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 149.28, "10th_percentile": 140.8, "90th_percentile": 149.28, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 140.8, "10th_percentile": 140.8, "90th_percentile": 149.28, "count": "1 through 10" } ] } ] }, { "description": "CD4/CD8 Ratio", "code_information": [ { "code": "86360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.75, "discounted_cash": 39.0, "minimum": 38.625, "maximum": 128.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.66, "10th_percentile": 39.66, "90th_percentile": 39.66, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 121.5, "10th_percentile": 121.5, "90th_percentile": 121.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.2, "10th_percentile": 41.2, "90th_percentile": 41.2, "count": "1 through 10" } ] } ] }, { "description": "INT REP HAND FT 2.6-7.5 FAC", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 173.0, "minimum": 167.625, "maximum": 506.7862, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 428.56, "10th_percentile": 428.56, "90th_percentile": 428.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 558.75, "10th_percentile": 558.75, "90th_percentile": 558.75, "count": "1 through 10" } ] } ] }, { "description": "Chromogranin A", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.75, "discounted_cash": 54.0, "minimum": 53.025, "maximum": 176.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.75 } ] } ] }, { "description": "CT Thoracic Spine w Contrast", "code_information": [ { "code": "72129", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1840.5, "discounted_cash": 570.0, "minimum": 552.15, "maximum": 1669.3335, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1528.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1528.9 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 989.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1736.25, "10th_percentile": 1736.25, "90th_percentile": 1736.25, "count": "1 through 10" } ] } ] }, { "description": "MMRI Breast BX Left EA Add Lesion 19086", "code_information": [ { "code": "19086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4684.5, "discounted_cash": 1452.0, "minimum": 900.0, "maximum": 4248.8415, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "Streptozyme Screen", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.0, "discounted_cash": 28.0, "minimum": 27.6, "maximum": 83.444, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.79 } ] } ] }, { "description": "CT Thorax w Contrast", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2532.25, "discounted_cash": 784.0, "minimum": 650.0, "maximum": 2296.7508, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1588.69, "10th_percentile": 1588.69, "90th_percentile": 1588.69, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 569.76, "10th_percentile": 537.53, "90th_percentile": 1139.51, "count": "25" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1526.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 826.53, "10th_percentile": 779.77, "90th_percentile": 826.53, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1526.93 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1912.16, "10th_percentile": 1912.16, "90th_percentile": 1988.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 987.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 725.32, "10th_percentile": 709.23, "90th_percentile": 764.48, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2532.25, "10th_percentile": 2389.0, "90th_percentile": 2532.25, "count": "44" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 785.0, "10th_percentile": 764.48, "90th_percentile": 810.32, "count": "62" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 2296.75, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 810.32, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 810.32, "count": "26" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 764.48, "10th_percentile": 764.48, "90th_percentile": 810.32, "count": "1 through 10" } ] } ] }, { "description": "Rad Ther Room Level 4", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.25, "discounted_cash": 72.0, "minimum": 69.975, "maximum": 211.5577, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 81.46, "10th_percentile": 81.46, "90th_percentile": 81.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 55.13, "10th_percentile": 55.13, "90th_percentile": 65.48, "count": "165" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.98, "10th_percentile": 39.98, "90th_percentile": 39.98, "count": "113" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 122.5, "10th_percentile": 77.75, "90th_percentile": 122.5, "count": "118" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 85.74, "10th_percentile": 84.07, "90th_percentile": 85.74, "count": "300" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.2, "10th_percentile": 39.2, "90th_percentile": 46.56, "count": "421" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 145.53, "10th_percentile": 48.78, "90th_percentile": 220.48, "count": "38" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 145.53, "10th_percentile": 9.31, "90th_percentile": 196.67, "count": "246" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.2, "10th_percentile": 39.2, "90th_percentile": 46.56, "count": "27" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.2, "10th_percentile": 39.2, "90th_percentile": 39.2, "count": "61" } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [ { "code": "228", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13093.0, "minimum": 13093.71, "maximum": 58324.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58324.8 } ] } ] }, { "description": "Potassium Serum", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.75, "discounted_cash": 9.0, "minimum": 8.925, "maximum": 29.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 19.78, "10th_percentile": 19.78, "90th_percentile": 19.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.18, "10th_percentile": 14.18, "90th_percentile": 14.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.71, "10th_percentile": 9.71, "90th_percentile": 9.71, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.36 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 20.03, "10th_percentile": 20.03, "90th_percentile": 24.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 29.75, "10th_percentile": 29.75, "90th_percentile": 31.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 10.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 23.73, "10th_percentile": 23.73, "90th_percentile": 23.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 133.5, "count": "12" } ] } ] }, { "description": "XR UGI Single 74240", "code_information": [ { "code": "74240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1085.75, "discounted_cash": 336.0, "minimum": 287.39, "maximum": 984.7753, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 287.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 389.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 389.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 719.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 327.76, "10th_percentile": 327.76, "90th_percentile": 327.76, "count": "1 through 10" } ] } ] }, { "description": "Alcohol, Isopropyl", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.0, "discounted_cash": 288.0, "minimum": 104.4951, "maximum": 845.324, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.5 } ] } ] }, { "description": "Bill Chr Anal CLL Cytogenetics", "code_information": [ { "code": "88275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 985.25, "discounted_cash": 305.0, "minimum": 256.93, "maximum": 893.6218, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 331.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 375.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 256.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 477.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 297.44, "10th_percentile": 297.44, "90th_percentile": 297.44, "count": "1 through 10" } ] } ] }, { "description": "MRSA DNA", "code_information": [ { "code": "87150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 54.0, "minimum": 53.1, "maximum": 177.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 163.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.0 } ] } ] }, { "description": "Bill IRL Cold Agg Titer", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.0, "discounted_cash": 73.0, "minimum": 51.57, "maximum": 214.052, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.13 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17816.0, "minimum": 17816.03, "maximum": 64041.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64041.28 } ] } ] }, { "description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CCMCC", "code_information": [ { "code": "760", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 11877.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11877.4 } ] } ] }, { "description": "U Cortisol, Random", "code_information": [ { "code": "82530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.5, "discounted_cash": 17.0, "minimum": 16.65, "maximum": 55.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 43.58, "10th_percentile": 43.58, "90th_percentile": 43.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 55.5, "10th_percentile": 55.5, "90th_percentile": 55.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.71, "10th_percentile": 16.71, "90th_percentile": 17.76, "count": "1 through 10" } ] } ] }, { "description": "CT Simulation Intermediate", "code_information": [ { "code": "77285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1353.25, "discounted_cash": 419.0, "minimum": 405.975, "maximum": 1353.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1070.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1353.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1353.25 } ] } ] }, { "description": "RADIOTHERAPY", "code_information": [ { "code": "849", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15240.0, "minimum": 15240.22, "maximum": 31942.24, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31942.24 } ] } ] }, { "description": "IHC ERA Quant 88360 AP Bill", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 154.0, "minimum": 149.25, "maximum": 497.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 497.5 } ] } ] }, { "description": "XR Cholecystogram", "code_information": [ { "code": "74290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 680.5, "discounted_cash": 210.0, "minimum": 192.58, "maximum": 617.2135, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 192.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 260.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 260.76 } ] } ] }, { "description": "CT Heart wo Dye Qual Calc", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.0, "discounted_cash": 78.0, "minimum": 75.9, "maximum": 253.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 246.9 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 253.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 253.0 } ] } ] }, { "description": "Biofeedback OT", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 37.0, "minimum": 36.0, "maximum": 108.84, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "11-Deoxycortisol, Quant, Blood", "code_information": [ { "code": "82634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.75, "discounted_cash": 98.0, "minimum": 95.025, "maximum": 287.2923, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.94 } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [ { "code": "970", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16098.0, "minimum": 16098.83, "maximum": 31092.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31092.26 } ] } ] }, { "description": "US Breast Right Complete", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.75, "discounted_cash": 151.0, "minimum": 146.925, "maximum": 489.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 397.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 397.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 489.75 } ] } ] }, { "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": 10088.0, "minimum": 10088.6, "maximum": 32503.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32503.4 } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "575", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 21184.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21184.8 } ] } ] }, { "description": "G6PD Screen", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.5, "discounted_cash": 19.0, "minimum": 19.35, "maximum": 64.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 21.05, "10th_percentile": 21.05, "90th_percentile": 21.05, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.64, "10th_percentile": 20.64, "90th_percentile": 20.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.64, "10th_percentile": 20.64, "90th_percentile": 20.64, "count": "1 through 10" } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "627", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2790.0, "minimum": 2790.46, "maximum": 15659.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15659.3 } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "630", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 17206.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17206.02 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 11449.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11449.46 } ] } ] }, { "description": "Dopamine Level", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.75, "discounted_cash": 77.0, "minimum": 75.225, "maximum": 235.87, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 235.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 161.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 80.24, "10th_percentile": 80.24, "90th_percentile": 80.24, "count": "1 through 10" } ] } ] }, { "description": "Giardia Antigen, Stool", "code_information": [ { "code": "87329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.75, "discounted_cash": 41.0, "minimum": 39.825, "maximum": 120.4043, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 96.94, "10th_percentile": 96.94, "90th_percentile": 96.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 40.88, "10th_percentile": 40.88, "90th_percentile": 40.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 125.25, "10th_percentile": 125.25, "90th_percentile": 132.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.98, "10th_percentile": 11.98, "90th_percentile": 40.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 40.08, "10th_percentile": 40.08, "90th_percentile": 42.48, "count": "1 through 10" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [ { "code": "698", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 19503.69, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 10303.25, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2146.51, "10th_percentile": 2146.51, "90th_percentile": 2146.51, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19503.69 } ] } ] }, { "description": "Helicobacterpylori Antigen, Stool", "code_information": [ { "code": "87338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.0, "discounted_cash": 125.0, "minimum": 73.43, "maximum": 367.335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 182.25, "10th_percentile": 182.25, "90th_percentile": 182.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 405.0, "10th_percentile": 382.0, "90th_percentile": 405.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.38, "10th_percentile": 14.38, "90th_percentile": 129.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 323.11, "10th_percentile": 323.11, "90th_percentile": 323.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 122.24, "10th_percentile": 122.24, "90th_percentile": 129.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.38, "10th_percentile": 14.38, "90th_percentile": 14.38, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 122.24, "10th_percentile": 122.24, "90th_percentile": 129.6, "count": "1 through 10" } ] } ] }, { "description": "EBV Nuclear Ab, IgG", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.5, "discounted_cash": 55.0, "minimum": 54.15, "maximum": 163.7135, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 113.22, "10th_percentile": 113.22, "90th_percentile": 113.22, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.44 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 136.27, "10th_percentile": 136.27, "90th_percentile": 136.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.53 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 170.25, "10th_percentile": 170.25, "90th_percentile": 180.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.76, "10th_percentile": 57.76, "90th_percentile": 57.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 100.87, "10th_percentile": 100.87, "90th_percentile": 100.87, "count": "1 through 10" } ] } ] }, { "description": "CT Thoracic Spine wo Contrast", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1640.0, "discounted_cash": 508.0, "minimum": 492.0, "maximum": 1487.48, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 535.3, "10th_percentile": 535.3, "90th_percentile": 535.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 730.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 495.12, "10th_percentile": 495.12, "90th_percentile": 495.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1547.25, "10th_percentile": 1547.25, "90th_percentile": 1640.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 524.8, "10th_percentile": 495.12, "90th_percentile": 524.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1487.48, "10th_percentile": 1487.48, "90th_percentile": 1487.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 524.8, "10th_percentile": 524.8, "90th_percentile": 524.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 524.8, "10th_percentile": 524.8, "90th_percentile": 524.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 524.8, "10th_percentile": 524.8, "90th_percentile": 524.8, "count": "1 through 10" } ] } ] }, { "description": "Staphylococcus Latex", "code_information": [ { "code": "87147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 9.0, "minimum": 9.3, "maximum": 31.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 16.29, "10th_percentile": 16.29, "90th_percentile": 23.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.7, "10th_percentile": 11.7, "90th_percentile": 13.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.55, "10th_percentile": 9.55, "90th_percentile": 10.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 16.54, "10th_percentile": 15.58, "90th_percentile": 21.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.5, "10th_percentile": 24.5, "90th_percentile": 29.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 26.0, "10th_percentile": 24.5, "90th_percentile": 31.0, "count": "69" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.36, "10th_percentile": 5.18, "90th_percentile": 19.84, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 23.58, "10th_percentile": 22.44, "90th_percentile": 51.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.36, "10th_percentile": 9.36, "90th_percentile": 15.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 8.32, "10th_percentile": 8.32, "90th_percentile": 8.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.2, "10th_percentile": 17.2, "90th_percentile": 17.2, "count": "1 through 10" } ] } ] }, { "description": "XR Fluoro Guide Needle Loc", "code_information": [ { "code": "77003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 528.75, "discounted_cash": 163.0, "minimum": 125.47, "maximum": 528.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 169.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.75 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 25668.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25668.15 } ] } ] }, { "description": "RECTAL RESECTION WITH CC", "code_information": [ { "code": "333", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7512.0, "minimum": 7512.79, "maximum": 27612.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27612.15 } ] } ] }, { "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": 3863.0, "minimum": 3863.72, "maximum": 23752.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23752.44 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [ { "code": "542", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10732.0, "minimum": 10732.55, "maximum": 20825.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20825.23 } ] } ] }, { "description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [ { "code": "069", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 10532.6599, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 4293.02, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2291.58, "10th_percentile": 2291.58, "90th_percentile": 2291.58, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9417.04 } ] } ] }, { "description": "Hepatitis B DNA Quant. RT-PCR", "code_information": [ { "code": "87517", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 645.25, "discounted_cash": 200.0, "minimum": 193.575, "maximum": 585.2418, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 608.75, "10th_percentile": 608.75, "90th_percentile": 645.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 194.8, "10th_percentile": 194.8, "90th_percentile": 194.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 557.61, "10th_percentile": 557.61, "90th_percentile": 557.61, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 194.8, "10th_percentile": 194.8, "90th_percentile": 194.8, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [ { "code": "207", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26831.0, "minimum": 26831.38, "maximum": 75858.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75858.55 } ] } ] }, { "description": ".Anaplasma phagocytophilum (HGA) Ab, IgG", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.25, "discounted_cash": 54.0, "minimum": 52.275, "maximum": 158.0447, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.89 } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [ { "code": "163", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13523.0, "minimum": 13523.01, "maximum": 52835.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52835.85 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 14106.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14106.69 } ] } ] }, { "description": "Methadone & Metabolite, Quant. Urine", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.5, "discounted_cash": 48.0, "minimum": 46.65, "maximum": 141.0385, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.3 } ] } ] }, { "description": "NM Brain Imaging Complete", "code_information": [ { "code": "78605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 434.0, "minimum": 420.525, "maximum": 1362.087, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 656.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 888.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 888.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1362.09 } ] } ] }, { "description": "XR Cholangiogram Intraoperative Addition", "code_information": [ { "code": "74301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1225.75, "discounted_cash": 379.0, "minimum": 81.71, "maximum": 1111.7552, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.31 } ] } ] }, { "description": "US Transrectal Prost Vol Study", "code_information": [ { "code": "76873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.0, "discounted_cash": 193.0, "minimum": 187.2, "maximum": 624.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 395.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 535.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 535.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.0 } ] } ] }, { "description": "Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.75, "discounted_cash": 39.0, "minimum": 38.025, "maximum": 114.9622, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.04, "10th_percentile": 57.04, "90th_percentile": 57.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.37, "10th_percentile": 41.37, "90th_percentile": 41.37, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 126.75, "10th_percentile": 126.75, "90th_percentile": 126.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 114.96, "10th_percentile": 114.96, "90th_percentile": 114.96, "count": "1 through 10" } ] } ] }, { "description": "Glucose Semi-Quantitative", "code_information": [ { "code": "81005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 17.0, "minimum": 13.85, "maximum": 49.885, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.23 } ] } ] }, { "description": "ORBITAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "113", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 27717.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27717.07 } ] } ] }, { "description": "CT Pelvis wo Contrast", "code_information": [ { "code": "72192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1780.0, "discounted_cash": 551.0, "minimum": 534.0, "maximum": 1614.46, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 580.99, "10th_percentile": 548.11, "90th_percentile": 580.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1679.25, "10th_percentile": 1679.25, "90th_percentile": 1780.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 569.6, "10th_percentile": 537.36, "90th_percentile": 569.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 569.6, "10th_percentile": 569.6, "90th_percentile": 569.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 537.36, "10th_percentile": 537.36, "90th_percentile": 569.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 569.6, "10th_percentile": 569.6, "90th_percentile": 569.6, "count": "1 through 10" } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "662", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15240.0, "minimum": 15240.22, "maximum": 36091.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36091.96 } ] } ] }, { "description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [ { "code": "152", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 13936.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13936.93 } ] } ] }, { "description": "Herpes Simplex Virus (HSV) Culture", "code_information": [ { "code": "87252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.25, "discounted_cash": 70.0, "minimum": 68.175, "maximum": 227.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.76 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 171.69, "10th_percentile": 171.69, "90th_percentile": 171.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 227.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 227.25, "10th_percentile": 214.5, "90th_percentile": 227.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 72.72, "10th_percentile": 72.72, "90th_percentile": 72.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 171.13, "10th_percentile": 171.13, "90th_percentile": 171.13, "count": "1 through 10" } ] } ] }, { "description": "US Scrotum Testes", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 832.0, "discounted_cash": 257.0, "minimum": 249.6, "maximum": 754.624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 638.14, "10th_percentile": 638.14, "90th_percentile": 638.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 374.4, "10th_percentile": 374.4, "90th_percentile": 374.4, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 472.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 472.12 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 529.15, "10th_percentile": 529.15, "90th_percentile": 642.91, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 653.37, "10th_percentile": 653.37, "90th_percentile": 653.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 595.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 832.0, "10th_percentile": 785.0, "90th_percentile": 832.0, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 251.2, "10th_percentile": 251.2, "90th_percentile": 266.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 719.06, "10th_percentile": 251.2, "90th_percentile": 754.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 266.24, "10th_percentile": 266.24, "90th_percentile": 266.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 266.24, "10th_percentile": 266.24, "90th_percentile": 266.24, "count": "1 through 10" } ] } ] }, { "description": "NM Testicular Scan w Flow", "code_information": [ { "code": "78761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 597.0, "discounted_cash": 185.0, "minimum": 179.1, "maximum": 597.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 597.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 597.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 597.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.0 } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 22035.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22035.96 } ] } ] }, { "description": "Metanephrines, Plasma", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 841.75, "discounted_cash": 260.0, "minimum": 108.4, "maximum": 763.4673, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 841.75, "10th_percentile": 841.75, "90th_percentile": 841.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 269.36, "10th_percentile": 269.36, "90th_percentile": 269.36, "count": "1 through 10" } ] } ] }, { "description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [ { "code": "884", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9873.0, "minimum": 9873.95, "maximum": 28144.0044, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9873.95, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 42631.0, "10th_percentile": 42631.0, "90th_percentile": 42631.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18967.29 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 12773.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12773.36 } ] } ] }, { "description": "Alpha-1 Globulins", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.5, "discounted_cash": 71.0, "minimum": 68.7, "maximum": 208.1565, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 176.03, "10th_percentile": 176.03, "90th_percentile": 177.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.28, "10th_percentile": 98.33, "90th_percentile": 103.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.91, "10th_percentile": 74.91, "90th_percentile": 74.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 145.96, "10th_percentile": 145.96, "90th_percentile": 145.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 218.5, "10th_percentile": 218.5, "90th_percentile": 229.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 229.5, "10th_percentile": 229.5, "90th_percentile": 229.5, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 73.44, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 208.16, "10th_percentile": 208.16, "90th_percentile": 208.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.44, "10th_percentile": 69.92, "90th_percentile": 73.44, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 73.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.92, "10th_percentile": 69.92, "90th_percentile": 69.92, "count": "1 through 10" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 72247.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72247.59 } ] } ] }, { "description": "MRI Breast Bilat w Contrast 77049", "code_information": [ { "code": "77049", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 939.0, "discounted_cash": 291.0, "minimum": 281.7, "maximum": 939.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 939.0 } ] } ] }, { "description": "US Transplanted Kidney Doppler", "code_information": [ { "code": "76776", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1250.25, "discounted_cash": 387.0, "minimum": 375.075, "maximum": 1133.9768, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 580.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 580.73 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.51 } ] } ] }, { "description": "XR Sialogram", "code_information": [ { "code": "70390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 791.0, "discounted_cash": 245.0, "minimum": 237.3, "maximum": 791.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 432.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 432.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 791.0 } ] } ] }, { "description": "CT Pudendal Nerve Injection 64430", "code_information": [ { "code": "64430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2938.25, "discounted_cash": 910.0, "minimum": 650.0, "maximum": 2664.9927, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "Acute Neb Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.25, "discounted_cash": 25.0, "minimum": 24.975, "maximum": 75.5078, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.49, "10th_percentile": 30.49, "90th_percentile": 30.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 22.11, "10th_percentile": 22.11, "90th_percentile": 22.11, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.75, "10th_percentile": 67.75, "90th_percentile": 67.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 67.75, "10th_percentile": 67.75, "90th_percentile": 67.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 21.68, "10th_percentile": 21.68, "90th_percentile": 21.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 4.34, "10th_percentile": 4.34, "90th_percentile": 4.34, "count": "1 through 10" } ] } ] }, { "description": "MRI Angio Head w Contrast", "code_information": [ { "code": "70545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1947.5, "discounted_cash": 603.0, "minimum": 584.25, "maximum": 1947.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1947.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1947.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1503.12 } ] } ] }, { "description": "NM MUGA Gated Cardiac SPECT", "code_information": [ { "code": "78494", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1029.25, "discounted_cash": 319.0, "minimum": 308.775, "maximum": 1029.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 891.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1029.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1029.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1029.25 } ] } ] }, { "description": "Stool, Occult Blood, 3 Screening Samples - 82270 - 3203002", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.5, "discounted_cash": 18.0, "minimum": 18.15, "maximum": 54.8735, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 3.33, "10th_percentile": 3.33, "90th_percentile": 3.33, "count": "1 through 10" } ] } ] }, { "description": "Nitrogen Washout/Lung Volumes", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.0, "discounted_cash": 183.0, "minimum": 177.9, "maximum": 537.851, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 170.09, "10th_percentile": 170.09, "90th_percentile": 186.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 109.69, "10th_percentile": 98.89, "90th_percentile": 266.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 161.46, "10th_percentile": 119.5, "90th_percentile": 392.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.56, "10th_percentile": 71.73, "90th_percentile": 193.56, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 179.98, "10th_percentile": 179.98, "90th_percentile": 179.98, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 175.89, "10th_percentile": 175.89, "90th_percentile": 175.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 61.36, "10th_percentile": 51.99, "90th_percentile": 299.45, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 186.96, "10th_percentile": 186.96, "90th_percentile": 186.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 243.75, "10th_percentile": 219.75, "90th_percentile": 593.0, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 78.0, "10th_percentile": 70.32, "90th_percentile": 78.0, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 221.08, "10th_percentile": 221.08, "90th_percentile": 221.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.06, "10th_percentile": 14.06, "90th_percentile": 70.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.32, "10th_percentile": 70.32, "90th_percentile": 78.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.32, "10th_percentile": 70.32, "90th_percentile": 78.0, "count": "1 through 10" } ] } ] }, { "description": "OT No Patient Present Train Initial 30 Min Unit", "code_information": [ { "code": "G0541", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.5, "minimum": 81.15, "maximum": 245.3435, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "IR Spinal Select Each Vessel", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3721.0, "discounted_cash": 1153.0, "minimum": 914.67, "maximum": 3374.947, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 914.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1238.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1238.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1147.76 } ] } ] }, { "description": "SALIVARY GLAND PROCEDURES", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 14567.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14567.64 } ] } ] }, { "description": "Continuous Nebulizer Treatment Initial", "code_information": [ { "code": "94644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.25, "discounted_cash": 130.0, "minimum": 126.075, "maximum": 381.1667, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 189.11, "10th_percentile": 189.11, "90th_percentile": 189.11, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 420.25, "10th_percentile": 400.25, "90th_percentile": 420.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.08, "10th_percentile": 128.08, "90th_percentile": 128.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.48, "10th_percentile": 128.08, "90th_percentile": 134.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.08, "10th_percentile": 128.08, "90th_percentile": 128.08, "count": "1 through 10" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 12051.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12051.87 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [ { "code": "814", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 25071.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25071.62 } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 17396.0831, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7323.31 } ] } ] }, { "description": "Inhibin A (Dimer)", "code_information": [ { "code": "86336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.75, "discounted_cash": 73.0, "minimum": 70.725, "maximum": 213.8253, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 128.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 99.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.32 } ] } ] }, { "description": "MRI Cervical Spine w+wo Contrast", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2471.5, "discounted_cash": 766.0, "minimum": 741.45, "maximum": 2471.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1112.18, "10th_percentile": 1112.18, "90th_percentile": 1112.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2471.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2471.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1875.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2471.5, "10th_percentile": 2471.5, "90th_percentile": 2471.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 790.88, "10th_percentile": 790.88, "90th_percentile": 790.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 790.88, "10th_percentile": 790.88, "90th_percentile": 790.88, "count": "1 through 10" } ] } ] }, { "description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CCMCC", "code_information": [ { "code": "489", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2575.0, "minimum": 2575.81, "maximum": 13165.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13165.93 } ] } ] }, { "description": "REM FB EYE SUPERFIC FAC", "code_information": [ { "code": "65205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.0, "discounted_cash": 98.0, "minimum": 95.7, "maximum": 289.333, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 319.0, "10th_percentile": 319.0, "90th_percentile": 319.0, "count": "1 through 10" } ] } ] }, { "description": "RENAL FAILURE WITH CC", "code_information": [ { "code": "683", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 12186.9947, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10324.79 } ] } ] }, { "description": "Sirolimus (Rapamycin) Level", "code_information": [ { "code": "80195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.25, "discounted_cash": 44.0, "minimum": 42.675, "maximum": 129.0207, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.99 } ] } ] }, { "description": "Cholinesterase, Serum", "code_information": [ { "code": "82480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.75, "discounted_cash": 60.0, "minimum": 50.43, "maximum": 176.6382, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 50.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.36 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [ { "code": "815", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 11954.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11954.03 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 22425.9986, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6439.53, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2291.58, "10th_percentile": 2291.58, "90th_percentile": 13749.48, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10557.03 } ] } ] }, { "description": "I-D ABSCESS TONSIL FAC", "code_information": [ { "code": "42700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.0, "discounted_cash": 119.0, "minimum": 115.2, "maximum": 348.288, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 122.88, "10th_percentile": 122.88, "90th_percentile": 122.88, "count": "1 through 10" } ] } ] }, { "description": "XR Elbow Left AP+Lateral", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.75, "discounted_cash": 97.0, "minimum": 75.84, "maximum": 285.4783, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 133.65, "10th_percentile": 133.65, "90th_percentile": 133.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 314.75, "10th_percentile": 314.75, "90th_percentile": 314.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 100.72, "10th_percentile": 100.72, "90th_percentile": 100.72, "count": "1 through 10" } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "628", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17816.0, "minimum": 17816.03, "maximum": 43935.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43935.17 } ] } ] }, { "description": "NM Hida Scan w Function", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.0, "discounted_cash": 404.0, "minimum": 391.5, "maximum": 1305.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1186.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1044.52, "10th_percentile": 1044.52, "90th_percentile": 1044.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 49787.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49787.22 } ] } ] }, { "description": "MRI Cardiac w+wo 75561", "code_information": [ { "code": "75561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1654.5, "discounted_cash": 512.0, "minimum": 496.35, "maximum": 1654.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1654.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1654.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1654.5 } ] } ] }, { "description": "XR Thoracic SP w Oblique 4 View", "code_information": [ { "code": "72074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 640.75, "discounted_cash": 198.0, "minimum": 135.67, "maximum": 581.1603, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 183.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 183.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.21 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [ { "code": "907", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14596.0, "minimum": 14596.27, "maximum": 45261.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45261.43 } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 13795.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13795.46 } ] } ] }, { "description": ".HPV Genotypes 16 & 18/45", "code_information": [ { "code": "87625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 305.25, "discounted_cash": 94.0, "minimum": 91.575, "maximum": 305.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 200.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 226.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 155.32 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 230.52, "10th_percentile": 230.52, "90th_percentile": 239.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 92.16, "10th_percentile": 92.16, "90th_percentile": 92.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.68, "10th_percentile": 97.68, "90th_percentile": 97.68, "count": "1 through 10" } ] } ] }, { "description": "Magnesium Sulfate IV Soln 4 GM/100ML (40 MG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "63323010600", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 57.91, "10th_percentile": 57.91, "90th_percentile": 173.72, "count": "1 through 10" } ] } ] }, { "description": "88302 AP Bill Surgical Pathology Level II Complexity", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.0, "discounted_cash": 127.0, "minimum": 123.6, "maximum": 373.684, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 224.05, "10th_percentile": 224.05, "90th_percentile": 224.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.84, "10th_percentile": 131.84, "90th_percentile": 131.84, "count": "1 through 10" } ] } ] }, { "description": "Vitamin B3 (Niacin) Level", "code_information": [ { "code": "84591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.25, "discounted_cash": 82.0, "minimum": 74.18, "maximum": 242.3957, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.26, "10th_percentile": 120.26, "90th_percentile": 120.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.03 } ] } ] }, { "description": "Clearance Creatinine Blood", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 15.0, "minimum": 15.0, "maximum": 47.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 33.25, "10th_percentile": 33.25, "90th_percentile": 33.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 22.5, "10th_percentile": 22.5, "90th_percentile": 22.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.32, "10th_percentile": 16.32, "90th_percentile": 16.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.77 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 31.8, "10th_percentile": 31.8, "90th_percentile": 31.8, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "18" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "50" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 45.35, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "1 through 10" } ] } ] }, { "description": "NON-EXTENSIVE BURNS", "code_information": [ { "code": "935", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 24285.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24285.3 } ] } ] }, { "description": "I-D PILONIDAL CYST FAC", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.25, "discounted_cash": 101.0, "minimum": 98.475, "maximum": 297.7228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 147.71, "10th_percentile": 147.71, "90th_percentile": 147.71, "count": "1 through 10" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "581", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 17012.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17012.68 } ] } ] }, { "description": "88311 AP Bill Decalcification", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.0, "discounted_cash": 34.0, "minimum": 33.6, "maximum": 101.584, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.11 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2790.0, "minimum": 2790.46, "maximum": 56124.98, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56124.98 } ] } ] }, { "description": "APh Plts (7d) LR, 1st cnt IRR - P9035 - 3000011 - 3000011", "code_information": [ { "code": "P9035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3685.25, "minimum": 1105.575, "maximum": 3342.5217, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 2940.09, "10th_percentile": 2940.09, "90th_percentile": 2940.09, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1179.28, "10th_percentile": 1179.28, "90th_percentile": 1179.28, "count": "1 through 10" } ] } ] }, { "description": "Methylmalonic Acid (MMA), Serum", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.25, "discounted_cash": 138.0, "minimum": 105.33, "maximum": 403.8417, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 341.51, "10th_percentile": 341.51, "90th_percentile": 341.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 200.36, "10th_percentile": 200.36, "90th_percentile": 200.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 145.33, "10th_percentile": 145.33, "90th_percentile": 145.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 566.36, "10th_percentile": 566.36, "90th_percentile": 566.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 379.3, "10th_percentile": 219.66, "90th_percentile": 445.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 445.25, "10th_percentile": 445.25, "90th_percentile": 445.25, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 403.84, "10th_percentile": 142.48, "90th_percentile": 407.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "1 through 10" } ] } ] }, { "description": "75893 FAC VEN SAMPLE SELECT RENIN", "code_information": [ { "code": "75893", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1478.75, "discounted_cash": 458.0, "minimum": 443.625, "maximum": 1341.2262, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 843.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1141.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1141.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 676.84 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [ { "code": "335", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18459.0, "minimum": 18459.99, "maximum": 42097.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42097.27 } ] } ] }, { "description": "Fructosamine", "code_information": [ { "code": "82985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.25, "discounted_cash": 47.0, "minimum": 46.275, "maximum": 154.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.35, "10th_percentile": 50.35, "90th_percentile": 50.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.44 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 123.46, "10th_percentile": 123.46, "90th_percentile": 123.46, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.25 } ] } ] }, { "description": "XR Sternum 2 Views", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 492.75, "discounted_cash": 152.0, "minimum": 90.44, "maximum": 446.9242, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 148.72, "10th_percentile": 148.72, "90th_percentile": 152.75, "count": "1 through 10" } ] } ] }, { "description": "$ AP 88346 Kidney Immunofluorescence, 1st", "code_information": [ { "code": "88346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.0, "discounted_cash": 40.0, "minimum": 39.0, "maximum": 130.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.0 } ] } ] }, { "description": "88333 AP Bill Non-Gyn Cytology Intraoperative consult", "code_information": [ { "code": "88333", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.5, "discounted_cash": 55.0, "minimum": 53.55, "maximum": 178.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.5 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "316", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 8041.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8041.26 } ] } ] }, { "description": "C. pneumoniae Antibody, IgM", "code_information": [ { "code": "86632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.0, "discounted_cash": 25.0, "minimum": 24.6, "maximum": 82.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.0 } ] } ] }, { "description": "MPL Mutation Analysis", "code_information": [ { "code": "81339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 915.25, "discounted_cash": 283.0, "minimum": 274.575, "maximum": 915.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 915.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 232.88, "10th_percentile": 232.88, "90th_percentile": 232.88, "count": "1 through 10" } ] } ] }, { "description": "ABSCESS DENTAL GUM FAC", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348.5, "discounted_cash": 108.0, "minimum": 104.55, "maximum": 316.0895, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 278.8, "10th_percentile": 278.8, "90th_percentile": 278.8, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 348.5, "10th_percentile": 332.0, "90th_percentile": 348.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 111.52, "10th_percentile": 111.52, "90th_percentile": 111.52, "count": "1 through 10" } ] } ] }, { "description": "ANOSCOPY FAC", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.25, "discounted_cash": 82.0, "minimum": 79.875, "maximum": 241.4888, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 242.0, "10th_percentile": 242.0, "90th_percentile": 242.0, "count": "1 through 10" } ] } ] }, { "description": "Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 29.0, "minimum": 28.35, "maximum": 85.7115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 62.84, "10th_percentile": 62.84, "90th_percentile": 62.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.53, "10th_percentile": 42.53, "90th_percentile": 42.53, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.84, "10th_percentile": 30.84, "90th_percentile": 30.84, "count": "36" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.08 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 75.6, "10th_percentile": 38.75, "90th_percentile": 77.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 75.64, "10th_percentile": 74.21, "90th_percentile": 75.64, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.64, "10th_percentile": 1.51, "90th_percentile": 94.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 72.48, "10th_percentile": 18.27, "90th_percentile": 73.14, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "268" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "77" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 85.71, "10th_percentile": 30.24, "90th_percentile": 86.56, "count": "32" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "58" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "46" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "1 through 10" } ] } ] }, { "description": "Phencyclidine (PCP), Urine Quantitative", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.0, "discounted_cash": 49.0, "minimum": 48.0, "maximum": 156.6029, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.6 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16098.0, "minimum": 16098.83, "maximum": 31903.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31903.34 } ] } ] }, { "description": "Hemosiderin, Urine", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.0, "discounted_cash": 25.0, "minimum": 24.3, "maximum": 73.467, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.28 } ] } ] }, { "description": "Protein, Body Fluid", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.0, "discounted_cash": 25.0, "minimum": 23.44, "maximum": 73.467, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 81.0, "10th_percentile": 81.0, "90th_percentile": 81.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "1 through 10" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 25839.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25839.09 } ] } ] }, { "description": "US RIGHT EXT COMP", "code_information": [ { "code": "76881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.0, "discounted_cash": 165.0, "minimum": 93.0915, "maximum": 501.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 501.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 501.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.09 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 8800.69, "maximum": 16720.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16720.31 } ] } ] }, { "description": "Diphenhydramine HCl Inj 50 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641037621", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 11.86, "10th_percentile": 11.86, "90th_percentile": 11.86, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 30.97, "10th_percentile": 30.97, "90th_percentile": 30.97, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 13.81, "10th_percentile": 13.81, "90th_percentile": 13.81, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 16071.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16071.92 } ] } ] }, { "description": "CA 19-9", "code_information": [ { "code": "86301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 34.0, "minimum": 33.3, "maximum": 111.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 81.08, "10th_percentile": 81.08, "90th_percentile": 81.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.23, "10th_percentile": 36.23, "90th_percentile": 36.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 33.52, "10th_percentile": 33.52, "90th_percentile": 35.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 33.52, "10th_percentile": 33.52, "90th_percentile": 35.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 33.52, "10th_percentile": 33.52, "90th_percentile": 33.52, "count": "1 through 10" } ] } ] }, { "description": "PSA (Prostate Specific Antigen) - G0103 - 3350213", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "minimum": 55.5, "maximum": 180.0001, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.25, "10th_percentile": 83.25, "90th_percentile": 83.25, "count": "41" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.38, "10th_percentile": 60.38, "90th_percentile": 60.38, "count": "15" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 185.0, "10th_percentile": 59.2, "90th_percentile": 185.0, "count": "16" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 18.8, "10th_percentile": 18.8, "90th_percentile": 18.8, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "71" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "45" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "1 through 10" } ] } ] }, { "description": "UA w/Reflex to Sediment Exam", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.5, "discounted_cash": 15.0, "minimum": 14.37, "maximum": 45.8035, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 16.16, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.16, "10th_percentile": 14.8, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 39.09, "10th_percentile": 35.47, "90th_percentile": 60.02, "count": "19" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 22.73, "10th_percentile": 20.81, "90th_percentile": 29.14, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.48, "10th_percentile": 15.1, "90th_percentile": 16.48, "count": "39" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 50.5, "10th_percentile": 50.5, "90th_percentile": 50.5, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.5, "10th_percentile": 46.25, "90th_percentile": 64.75, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 35.47, "10th_percentile": 30.76, "90th_percentile": 39.09, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 50.5, "10th_percentile": 46.25, "90th_percentile": 50.5, "count": "147" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.16, "10th_percentile": 14.8, "90th_percentile": 20.72, "count": "111" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 41.95, "10th_percentile": 14.8, "90th_percentile": 46.26, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.16, "10th_percentile": 14.8, "90th_percentile": 20.72, "count": "52" } ] } ] }, { "description": "Alpha Fetoprotein, Serum, Tumor Marker", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.25, "discounted_cash": 68.0, "minimum": 66.075, "maximum": 199.7668, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 170.47, "10th_percentile": 170.47, "90th_percentile": 170.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 71.89, "10th_percentile": 71.89, "90th_percentile": 71.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.24, "10th_percentile": 74.24, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 220.25, "10th_percentile": 220.25, "90th_percentile": 220.25, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 201.75, "10th_percentile": 201.75, "90th_percentile": 201.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" } ] } ] }, { "description": "Alk Phos, Total", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.5, "discounted_cash": 20.0, "minimum": 19.95, "maximum": 60.3155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 51.47, "10th_percentile": 51.47, "90th_percentile": 51.47, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 29.93, "10th_percentile": 29.93, "90th_percentile": 29.93, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 21.71, "10th_percentile": 21.71, "90th_percentile": 21.71, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 33.77, "10th_percentile": 33.77, "90th_percentile": 33.77, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 66.5, "10th_percentile": 48.75, "90th_percentile": 66.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 21.28, "10th_percentile": 20.62, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.6, "10th_percentile": 15.6, "90th_percentile": 21.28, "count": "1 through 10" } ] } ] }, { "description": "XR Facial Bones 1-2 Views", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.0, "discounted_cash": 95.0, "minimum": 81.71, "maximum": 279.356, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 308.0, "10th_percentile": 308.0, "90th_percentile": 308.0, "count": "1 through 10" } ] } ] }, { "description": "Bill Celiac Plus HLA-DQA1", "code_information": [ { "code": "81382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860.75, "discounted_cash": 266.0, "minimum": 258.225, "maximum": 860.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 555.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 628.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 430.39 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 860.75 } ] } ] }, { "description": "US Pseudoaneurysm Compression", "code_information": [ { "code": "76936", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 555.5, "discounted_cash": 172.0, "minimum": 166.65, "maximum": 555.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 382.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 517.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 555.5 } ] } ] }, { "description": "SPLENIC PROCEDURES WITH MCC", "code_information": [ { "code": "799", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14596.0, "minimum": 14596.27, "maximum": 53391.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53391.11 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 12497.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12497.5 } ] } ] }, { "description": "NM Brain SPECT CT 78835", "code_information": [ { "code": "78835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 897.75, "discounted_cash": 278.0, "minimum": 269.325, "maximum": 814.2592, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.08 } ] } ] }, { "description": "NM Shunt Peritoneal Venous Patent", "code_information": [ { "code": "78291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 837.0, "discounted_cash": 259.0, "minimum": 251.1, "maximum": 837.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 773.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 837.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 837.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 837.0 } ] } ] }, { "description": "75860 FAC VENOGRAPHY VENOUS SINUS", "code_information": [ { "code": "75860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2078.0, "discounted_cash": 644.0, "minimum": 617.6279, "maximum": 1884.746, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 859.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1163.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1163.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.63 } ] } ] }, { "description": "XR Thoracic Spine AP+Lateral", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 486.75, "discounted_cash": 150.0, "minimum": 90.44, "maximum": 441.4823, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 376.74, "10th_percentile": 376.74, "90th_percentile": 376.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 219.04, "10th_percentile": 219.04, "90th_percentile": 219.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 149.9, "10th_percentile": 149.9, "90th_percentile": 149.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 292.08, "10th_percentile": 292.08, "90th_percentile": 398.65, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 367.58, "10th_percentile": 367.58, "90th_percentile": 382.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 146.96, "10th_percentile": 146.96, "90th_percentile": 155.76, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 459.25, "10th_percentile": 459.25, "90th_percentile": 486.75, "count": "17" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 155.76, "10th_percentile": 146.96, "90th_percentile": 155.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 29.39, "10th_percentile": 29.39, "90th_percentile": 441.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 146.96, "10th_percentile": 146.96, "90th_percentile": 259.37, "count": "11" } ] } ] }, { "description": "Chemo IV Each Addl Suquential 0 - 1 Hr", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 362.25, "discounted_cash": 112.0, "minimum": 108.675, "maximum": 328.5607, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 163.01, "10th_percentile": 155.25, "90th_percentile": 310.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 239.95, "10th_percentile": 191.96, "90th_percentile": 239.95, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 579.6, "10th_percentile": 579.6, "90th_percentile": 579.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 362.25, "10th_percentile": 362.25, "90th_percentile": 362.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 345.0, "10th_percentile": 345.0, "90th_percentile": 345.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 115.92, "10th_percentile": 115.92, "90th_percentile": 115.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 115.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 115.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 115.92, "count": "1 through 10" } ] } ] }, { "description": "HIV-1 RNA by PCR", "code_information": [ { "code": "87536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632.0, "discounted_cash": 195.0, "minimum": 189.6, "maximum": 632.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 463.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 524.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 194.62, "10th_percentile": 194.62, "90th_percentile": 194.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 359.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 632.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 596.25, "10th_percentile": 596.25, "90th_percentile": 596.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 190.8, "10th_percentile": 190.8, "90th_percentile": 190.8, "count": "1 through 10" } ] } ] }, { "description": "TREATMENT OF THIGH FRACTURE FAC", "code_information": [ { "code": "27510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2383.75, "discounted_cash": 738.0, "minimum": 715.125, "maximum": 2162.0613, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 5027.23, "10th_percentile": 5027.23, "90th_percentile": 5027.23, "count": "1 through 10" } ] } ] }, { "description": "SHORT ARM SPLINT FAC", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.5, "discounted_cash": 88.0, "minimum": 85.65, "maximum": 258.9485, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 218.98, "10th_percentile": 218.98, "90th_percentile": 218.98, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 217.71, "10th_percentile": 217.71, "90th_percentile": 217.71, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 285.5, "10th_percentile": 272.0, "90th_percentile": 285.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 258.95, "10th_percentile": 258.95, "90th_percentile": 258.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 91.36, "10th_percentile": 91.36, "90th_percentile": 91.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 91.36, "10th_percentile": 91.36, "90th_percentile": 91.36, "count": "1 through 10" } ] } ] }, { "description": "XR Acromid Clavicular Joints Bilateral", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 475.75, "discounted_cash": 147.0, "minimum": 100.68, "maximum": 431.5052, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.18 } ] } ] }, { "description": "Rheumatoid Factor", "code_information": [ { "code": "86431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.75, "discounted_cash": 41.0, "minimum": 36.32, "maximum": 120.4043, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 96.94, "10th_percentile": 96.94, "90th_percentile": 101.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.36, "10th_percentile": 56.36, "90th_percentile": 56.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 40.88, "10th_percentile": 40.88, "90th_percentile": 43.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 79.66, "10th_percentile": 79.66, "90th_percentile": 84.43, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 104.25, "10th_percentile": 104.25, "90th_percentile": 104.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 125.25, "10th_percentile": 125.25, "90th_percentile": 132.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 125.25, "10th_percentile": 125.25, "90th_percentile": 132.75, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 120.4, "10th_percentile": 120.4, "90th_percentile": 120.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.48, "10th_percentile": 40.08, "90th_percentile": 42.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.48, "count": "1 through 10" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "314", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 24582.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24582.38 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 8800.69, "maximum": 18913.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18913.06 } ] } ] }, { "description": "NM Brain Imaging Limited Static", "code_information": [ { "code": "78600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 434.0, "minimum": 420.525, "maximum": 1271.3872, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 596.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 807.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 807.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1252.13 } ] } ] }, { "description": "IMMUNO EHEC test", "code_information": [ { "code": "87427", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 9.0, "minimum": 9.3, "maximum": 31.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.55, "10th_percentile": 9.55, "90th_percentile": 9.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 24.34, "10th_percentile": 24.34, "90th_percentile": 24.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 31.0, "10th_percentile": 29.25, "90th_percentile": 31.0, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.92, "10th_percentile": 9.36, "90th_percentile": 11.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 9.92, "10th_percentile": 9.92, "90th_percentile": 9.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.36, "10th_percentile": 9.36, "90th_percentile": 9.92, "count": "1 through 10" } ] } ] }, { "description": "76000 FAC FLUORO LESS THAN 1 HOUR", "code_information": [ { "code": "76000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 530.5, "discounted_cash": 164.0, "minimum": 159.15, "maximum": 481.1635, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 456.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 456.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 531.5, "10th_percentile": 531.5, "90th_percentile": 531.5, "count": "1 through 10" } ] } ] }, { "description": "Morphine Sulfate Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641612725", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.03, "10th_percentile": 6.03, "90th_percentile": 6.03, "count": "1 through 10" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016502", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 15.5, "10th_percentile": 15.5, "90th_percentile": 15.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 10.57, "10th_percentile": 10.57, "90th_percentile": 10.57, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 21550.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21550.26 } ] } ] }, { "description": "PERITINEOCNTSIS W/IMG FAC", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2053.75, "discounted_cash": 636.0, "minimum": 616.125, "maximum": 1862.7513, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 670.34, "10th_percentile": 670.34, "90th_percentile": 670.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 657.2, "10th_percentile": 657.2, "90th_percentile": 657.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 657.2, "10th_percentile": 657.2, "90th_percentile": 657.2, "count": "1 through 10" } ] } ] }, { "description": "Carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.5, "discounted_cash": 31.0, "minimum": 30.75, "maximum": 92.9675, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.95 } ] } ] }, { "description": "KAPPA ISH 88365 Bill", "code_information": [ { "code": "88365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 99.0, "minimum": 96.0, "maximum": 320.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.0 } ] } ] }, { "description": "URETHRAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "672", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3434.0, "minimum": 3434.42, "maximum": 12726.2, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12726.2 } ] } ] }, { "description": "Echo 3D Recon w Post Proc on WS", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 807.25, "discounted_cash": 250.0, "minimum": 242.175, "maximum": 732.1757, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 291.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 395.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 395.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.02 } ] } ] }, { "description": "Cholesterol", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.0, "discounted_cash": 14.0, "minimum": 14.4, "maximum": 43.536, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.67, "10th_percentile": 15.67, "90th_percentile": 15.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.36, "10th_percentile": 14.88, "90th_percentile": 15.36, "count": "1 through 10" } ] } ] }, { "description": "Pancreatic Elastase, Fecal", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 374.5, "discounted_cash": 116.0, "minimum": 82.85, "maximum": 339.6715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 289.86, "10th_percentile": 289.86, "90th_percentile": 289.86, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 122.24, "10th_percentile": 122.24, "90th_percentile": 122.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 374.5, "10th_percentile": 195.0, "90th_percentile": 374.5, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.27, "10th_percentile": 17.27, "90th_percentile": 119.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 119.84, "10th_percentile": 119.84, "90th_percentile": 339.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.84, "10th_percentile": 119.84, "90th_percentile": 119.84, "count": "1 through 10" } ] } ] }, { "description": "Diph, Acellular Pert & Tet Tox Inj 25 LF-58 MCG-10 LF/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "58160081052", "type": "NDC" }, { "code": "90700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 0.01, "10th_percentile": 0.01, "90th_percentile": 0.01, "count": "1 through 10" } ] } ] }, { "description": "UGT1A1 Gene Polymorphism (TA Repeat)", "code_information": [ { "code": "81350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.5, "discounted_cash": 204.0, "minimum": 177.23, "maximum": 660.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 228.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 258.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 177.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 660.5 } ] } ] }, { "description": "Urine, Drug Panel 6 with Confirmation", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.5, "discounted_cash": 80.0, "minimum": 77.55, "maximum": 258.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 162.09, "10th_percentile": 162.09, "90th_percentile": 162.09, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 116.33, "10th_percentile": 65.36, "90th_percentile": 210.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 258.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 258.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 84.37, "10th_percentile": 50.27, "90th_percentile": 161.81, "count": "52" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 258.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 155.03, "10th_percentile": 123.2, "90th_percentile": 164.41, "count": "20" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 203.0, "10th_percentile": 195.1, "90th_percentile": 389.31, "count": "35" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 100.89, "10th_percentile": 12.32, "90th_percentile": 258.5, "count": "32" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 162.09, "10th_percentile": 118.12, "90th_percentile": 198.27, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 379.5, "10th_percentile": 154.0, "90th_percentile": 495.75, "count": "693" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 82.72, "10th_percentile": 49.28, "90th_percentile": 158.64, "count": "66" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 271.55, "10th_percentile": 223.28, "90th_percentile": 871.72, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 82.72, "10th_percentile": 49.28, "90th_percentile": 345.0, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.48, "10th_percentile": 46.48, "90th_percentile": 172.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 158.64, "10th_percentile": 82.72, "90th_percentile": 158.64, "count": "28" } ] } ] }, { "description": "JAK2 V617F Mutation Analysis", "code_information": [ { "code": "81270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1464.5, "discounted_cash": 453.0, "minimum": 112.56, "maximum": 1328.3015, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 854.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 372.56, "10th_percentile": 372.56, "90th_percentile": 468.64, "count": "1 through 10" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 9503.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9503.1 } ] } ] }, { "description": "TDES Bx Diabetic Education", "code_information": [ { "code": "S0320", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.25, "minimum": 26.475, "maximum": 80.0427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 58.79, "10th_percentile": 58.79, "90th_percentile": 58.79, "count": "1 through 10" } ] } ] }, { "description": "OT No Patient Present Trn Ea Add 15 Min Unit", "code_information": [ { "code": "G0542", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.25, "minimum": 40.575, "maximum": 122.6718, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "855", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 17650.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17650.46 } ] } ] }, { "description": "IR Lymphangiogram Pelvic-Abd Uni LT 75805", "code_information": [ { "code": "75805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9735.25, "discounted_cash": 3017.0, "minimum": 967.22, "maximum": 8829.8718, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 967.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1309.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1309.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1821.74 } ] } ] }, { "description": "Blastomyces Antibody by ID", "code_information": [ { "code": "86612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 57.0, "minimum": 55.5, "maximum": 167.795, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.25 } ] } ] }, { "description": "Testos Total Male ED/LC-MS/MS", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.75, "discounted_cash": 86.0, "minimum": 83.325, "maximum": 251.9193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 184.7, "10th_percentile": 184.7, "90th_percentile": 184.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 124.99, "10th_percentile": 124.99, "90th_percentile": 124.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 213.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 241.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 165.18 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 176.65, "10th_percentile": 176.65, "90th_percentile": 176.65, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 222.31, "10th_percentile": 218.12, "90th_percentile": 222.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 242.72, "10th_percentile": 183.52, "90th_percentile": 260.72, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 184.7, "10th_percentile": 184.7, "90th_percentile": 184.7, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 277.75, "10th_percentile": 277.75, "90th_percentile": 277.75, "count": "36" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 88.88, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 251.92, "10th_percentile": 88.88, "90th_percentile": 254.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 170.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 88.88, "count": "1 through 10" } ] } ] }, { "description": "Haptoglob", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.25, "discounted_cash": 47.0, "minimum": 45.675, "maximum": 138.0908, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.51, "10th_percentile": 68.51, "90th_percentile": 68.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.49 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 96.83, "10th_percentile": 96.83, "90th_percentile": 96.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 11820.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11820.81 } ] } ] }, { "description": "CEA, Peritoneal Fluid", "code_information": [ { "code": "82378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.0, "discounted_cash": 73.0, "minimum": 71.1, "maximum": 214.959, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 157.61, "10th_percentile": 157.61, "90th_percentile": 157.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 106.65, "10th_percentile": 106.65, "90th_percentile": 106.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 156.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 77.36, "10th_percentile": 77.36, "90th_percentile": 77.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.37 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 150.73, "10th_percentile": 150.73, "90th_percentile": 150.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 189.69, "10th_percentile": 186.12, "90th_percentile": 189.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 183.92, "10th_percentile": 165.28, "90th_percentile": 237.0, "count": "11" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 237.0, "10th_percentile": 237.0, "90th_percentile": 237.0, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 75.84, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 214.96, "10th_percentile": 75.84, "90th_percentile": 217.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 75.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 75.84, "count": "1 through 10" } ] } ] }, { "description": "MRI Angio Head w+wo Contrast", "code_information": [ { "code": "70546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2948.5, "discounted_cash": 914.0, "minimum": 884.55, "maximum": 2948.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2948.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2948.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2287.06 } ] } ] }, { "description": "Tobra", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.75, "discounted_cash": 67.0, "minimum": 65.025, "maximum": 196.5923, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 133.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 103.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.36 } ] } ] }, { "description": "CT Urogram 74178", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3122.5, "discounted_cash": 967.0, "minimum": 650.0, "maximum": 2832.1075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1958.92, "10th_percentile": 1958.92, "90th_percentile": 1958.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1405.13, "10th_percentile": 1325.59, "90th_percentile": 1405.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1931.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1019.18, "10th_percentile": 961.49, "90th_percentile": 1019.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1931.9 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 2452.1, "10th_percentile": 2452.1, "90th_percentile": 2452.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2162.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 914.2, "10th_percentile": 857.64, "90th_percentile": 914.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2945.75, "10th_percentile": 2945.75, "90th_percentile": 3122.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 999.2, "10th_percentile": 942.64, "90th_percentile": 999.2, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 999.2, "10th_percentile": 942.64, "90th_percentile": 2832.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 999.2, "10th_percentile": 942.64, "90th_percentile": 999.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 942.64, "10th_percentile": 942.64, "90th_percentile": 942.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 999.2, "10th_percentile": 999.2, "90th_percentile": 999.2, "count": "1 through 10" } ] } ] }, { "description": "Acetylcholine Receptor Binding Ab", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.75, "discounted_cash": 168.0, "minimum": 86.45, "maximum": 492.2742, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 182.0, "10th_percentile": 182.0, "90th_percentile": 182.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 173.68, "10th_percentile": 43.04, "90th_percentile": 1166.08, "count": "1 through 10" } ] } ] }, { "description": "Protein Total - 84155 - 3107017 - 3107017", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.5, "discounted_cash": 23.0, "minimum": 22.65, "maximum": 68.4785, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 58.44, "10th_percentile": 58.44, "90th_percentile": 58.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.4, "10th_percentile": 32.4, "90th_percentile": 33.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 72.0, "10th_percentile": 72.0, "90th_percentile": 72.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 75.5, "10th_percentile": 75.5, "90th_percentile": 75.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.16, "10th_percentile": 24.16, "90th_percentile": 24.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 23.04, "10th_percentile": 23.04, "90th_percentile": 24.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 23.04, "10th_percentile": 23.04, "90th_percentile": 23.04, "count": "1 through 10" } ] } ] }, { "description": "XR TM Joints Unilateral", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.25, "discounted_cash": 96.0, "minimum": 81.71, "maximum": 281.3967, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.99 } ] } ] }, { "description": "XR Abdomen 3+ Views 74021", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.25, "discounted_cash": 190.0, "minimum": 103.39, "maximum": 558.0317, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 216.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.6 } ] } ] }, { "description": "Allergen, Apple IgE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.25, "discounted_cash": 14.0, "minimum": 14.475, "maximum": 48.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.22, "10th_percentile": 123.22, "90th_percentile": 123.22, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.39 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 50.24, "10th_percentile": 50.24, "90th_percentile": 100.49, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 958.6, "10th_percentile": 958.6, "90th_percentile": 958.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 758.25, "10th_percentile": 48.25, "90th_percentile": 1439.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 681.73, "10th_percentile": 681.73, "90th_percentile": 681.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.64, "10th_percentile": 15.44, "90th_percentile": 450.88, "count": "1 through 10" } ] } ] }, { "description": "D-Dimer", "code_information": [ { "code": "85380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.75, "discounted_cash": 46.0, "minimum": 44.925, "maximum": 135.8233, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 119.8, "10th_percentile": 115.68, "90th_percentile": 122.65, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 113.06, "10th_percentile": 113.06, "90th_percentile": 117.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.89 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 109.33, "10th_percentile": 109.33, "90th_percentile": 109.33, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 149.75, "10th_percentile": 141.25, "90th_percentile": 149.75, "count": "75" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 47.92, "10th_percentile": 45.2, "90th_percentile": 47.92, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 129.38, "10th_percentile": 47.92, "90th_percentile": 135.82, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.2, "10th_percentile": 45.2, "90th_percentile": 47.92, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.2, "10th_percentile": 45.2, "90th_percentile": 47.92, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 93.93, "10th_percentile": 93.93, "90th_percentile": 93.93, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.56, "10th_percentile": 63.56, "90th_percentile": 67.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.1, "10th_percentile": 46.1, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 65.07 } ] } ] }, { "description": "MTB MIC", "code_information": [ { "code": "87188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.25, "discounted_cash": 15.0, "minimum": 15.075, "maximum": 50.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.25 } ] } ] }, { "description": "DISTAL RADIAL FX MAN FAC", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 756.25, "discounted_cash": 234.0, "minimum": 226.875, "maximum": 685.9188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 580.04, "10th_percentile": 580.04, "90th_percentile": 580.04, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 756.25, "10th_percentile": 756.25, "90th_percentile": 756.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 230.48, "10th_percentile": 230.48, "90th_percentile": 242.0, "count": "1 through 10" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 31358.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31358.69 } ] } ] }, { "description": "Mycoplasma pneumoniae", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 18.0, "minimum": 18.3, "maximum": 61.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.77, "10th_percentile": 18.77, "90th_percentile": 19.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 49.96, "10th_percentile": 49.96, "90th_percentile": 49.96, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 47.9, "10th_percentile": 47.9, "90th_percentile": 47.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 46.79, "10th_percentile": 46.79, "90th_percentile": 46.79, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 57.5, "10th_percentile": 57.5, "90th_percentile": 61.0, "count": "73" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 19.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 19.52, "10th_percentile": 19.52, "90th_percentile": 55.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.52, "10th_percentile": 19.52, "90th_percentile": 19.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.52, "10th_percentile": 18.4, "90th_percentile": 19.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" } ] } ] }, { "description": "Wheelchair Mgmt Training/15 min OT", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.75, "discounted_cash": 28.0, "minimum": 27.225, "maximum": 90.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.75 } ] } ] }, { "description": "NM Renal Scan w Flow", "code_information": [ { "code": "78701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.5, "discounted_cash": 195.0, "minimum": 189.15, "maximum": 630.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 630.5 } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 37458.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37458.31 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 12664.41, "maximum": 38942.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38942.54 } ] } ] }, { "description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "747", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2790.0, "minimum": 2790.46, "maximum": 10134.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10134.99 } ] } ] }, { "description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [ { "code": "794", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 17399.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17399.36 } ] } ] }, { "description": "Barbiturate, Urine Quantitative - 80345 - 3350616", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.0, "discounted_cash": 51.0, "minimum": 50.1, "maximum": 151.469, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.61 } ] } ] }, { "description": "77011 FAC CT STEALTH LUMBAR", "code_information": [ { "code": "77011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 794.0, "discounted_cash": 246.0, "minimum": 238.2, "maximum": 794.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 794.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 794.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 794.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 794.0 } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 12664.41, "maximum": 24465.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24465.67 } ] } ] }, { "description": "US Pelvis Complete", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 944.5, "discounted_cash": 292.0, "minimum": 283.35, "maximum": 856.6615, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 592.52, "10th_percentile": 592.52, "90th_percentile": 592.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 466.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 290.82, "10th_percentile": 290.82, "90th_percentile": 308.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 466.2 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 566.68, "10th_percentile": 566.68, "90th_percentile": 566.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 713.16, "10th_percentile": 713.16, "90th_percentile": 741.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 620.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 285.12, "10th_percentile": 285.12, "90th_percentile": 285.12, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 724.43, "10th_percentile": 724.43, "90th_percentile": 724.43, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 944.5, "10th_percentile": 891.0, "90th_percentile": 944.5, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 285.12, "10th_percentile": 285.12, "90th_percentile": 302.24, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 816.16, "10th_percentile": 710.84, "90th_percentile": 856.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 302.24, "10th_percentile": 285.12, "90th_percentile": 856.66, "count": "1 through 10" } ] } ] }, { "description": "Insulin, Random", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.75, "discounted_cash": 56.0, "minimum": 54.825, "maximum": 165.7543, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 82.24, "10th_percentile": 82.24, "90th_percentile": 82.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.65, "10th_percentile": 59.65, "90th_percentile": 59.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.13 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 116.23, "10th_percentile": 116.23, "90th_percentile": 116.23, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 146.27, "10th_percentile": 146.27, "90th_percentile": 146.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 182.75, "10th_percentile": 182.75, "90th_percentile": 182.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.48, "10th_percentile": 58.48, "90th_percentile": 58.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 167.4, "10th_percentile": 167.4, "90th_percentile": 167.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.48, "10th_percentile": 58.48, "90th_percentile": 58.48, "count": "1 through 10" } ] } ] }, { "description": "NM Lung Ventilation Only", "code_information": [ { "code": "78579", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 713.25, "discounted_cash": 221.0, "minimum": 213.975, "maximum": 713.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 612.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 713.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 713.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.25 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12235.0, "minimum": 12235.11, "maximum": 42357.6564, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 12235.11, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 14920.85, "10th_percentile": 14920.85, "90th_percentile": 14920.85, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27386.98 } ] } ] }, { "description": "Occult Blood, Stool", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 13.0, "minimum": 13.2, "maximum": 39.908, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 34.06, "10th_percentile": 34.06, "90th_percentile": 34.06, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.8, "10th_percentile": 19.8, "90th_percentile": 19.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.36, "10th_percentile": 14.36, "90th_percentile": 14.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 4.23, "10th_percentile": 4.23, "90th_percentile": 4.23, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 44.0, "10th_percentile": 44.0, "90th_percentile": 44.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.08, "10th_percentile": 4.23, "90th_percentile": 14.08, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 40.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 14.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 4.23, "10th_percentile": 4.23, "90th_percentile": 14.08, "count": "1 through 10" } ] } ] }, { "description": "NM Lung Quant Vent w Perf", "code_information": [ { "code": "78598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1114.25, "discounted_cash": 345.0, "minimum": 334.275, "maximum": 1114.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1064.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1114.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1114.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1114.25 } ] } ] }, { "description": "Glucose, Fasting", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.5, "discounted_cash": 20.0, "minimum": 19.95, "maximum": 60.3155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 42.57, "10th_percentile": 42.57, "90th_percentile": 42.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.98, "10th_percentile": 24.98, "90th_percentile": 24.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.12, "10th_percentile": 18.12, "90th_percentile": 18.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 35.3, "10th_percentile": 35.3, "90th_percentile": 35.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 43.58, "10th_percentile": 43.58, "90th_percentile": 43.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.13, "10th_percentile": 37.13, "90th_percentile": 37.13, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 35.49, "10th_percentile": 35.49, "90th_percentile": 35.49, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 3.93, "10th_percentile": 3.93, "90th_percentile": 3.93, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.76, "10th_percentile": 17.76, "90th_percentile": 17.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 50.34, "10th_percentile": 50.34, "90th_percentile": 50.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.76, "10th_percentile": 17.76, "90th_percentile": 17.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.76, "10th_percentile": 17.76, "90th_percentile": 17.76, "count": "1 through 10" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC", "code_information": [ { "code": "737", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 24292.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24292.37 } ] } ] }, { "description": "MRI Protocol created for patient 76017", "code_information": [ { "code": "76017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 725.25, "discounted_cash": 224.0, "minimum": 217.575, "maximum": 725.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 725.25 } ] } ] }, { "description": "Famotidine in NaCl 0.9% IV Soln 20 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338519741", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 57.91, "10th_percentile": 57.91, "90th_percentile": 57.91, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 29.43, "10th_percentile": 29.43, "90th_percentile": 29.43, "count": "1 through 10" } ] } ] }, { "description": "NM Monoclonal Antibody Therapy", "code_information": [ { "code": "79403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3022.25, "discounted_cash": 936.0, "minimum": 415.78, "maximum": 2741.1807, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 415.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 562.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 562.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 854.49 } ] } ] }, { "description": "CT Spine Procedure", "code_information": [ { "code": "22899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.5, "discounted_cash": 158.0, "minimum": 153.75, "maximum": 512.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 512.5 } ] } ] }, { "description": "White Blood Cell", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.0, "discounted_cash": 17.0, "minimum": 16.26, "maximum": 52.606, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.75, "10th_percentile": 54.75, "90th_percentile": 54.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 58.0, "10th_percentile": 58.0, "90th_percentile": 58.0, "count": "1 through 10" } ] } ] }, { "description": "XR Skull 1-3 Views", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.5, "discounted_cash": 121.0, "minimum": 96.27, "maximum": 355.9975, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 392.5, "10th_percentile": 392.5, "90th_percentile": 392.5, "count": "1 through 10" } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [ { "code": "620", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 18865.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18865.9 } ] } ] }, { "description": "Plasminogen Activator Inhib.1, Activity", "code_information": [ { "code": "85415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.0, "discounted_cash": 59.0, "minimum": 57.9, "maximum": 175.051, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 141.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.24 } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC", "code_information": [ { "code": "319", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15884.0, "minimum": 15884.17, "maximum": 52613.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52613.04 } ] } ] }, { "description": "Glucose, 2 Hour", "code_information": [ { "code": "82950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.25, "discounted_cash": 21.0, "minimum": 20.475, "maximum": 61.9027, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 37.91, "10th_percentile": 37.91, "90th_percentile": 37.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 4.75, "10th_percentile": 4.75, "90th_percentile": 4.75, "count": "1 through 10" } ] } ] }, { "description": "P jiro DFA", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "discounted_cash": 51.0, "minimum": 49.875, "maximum": 150.7887, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.08 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "700", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 8133.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8133.22 } ] } ] }, { "description": "I-D BARTH GLAND ABSCESS FAC", "code_information": [ { "code": "56420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 546.5, "discounted_cash": 169.0, "minimum": 163.95, "maximum": 495.6755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 402.87, "10th_percentile": 402.87, "90th_percentile": 402.87, "count": "1 through 10" } ] } ] }, { "description": "Gamma Glutamyl Transferase", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.75, "discounted_cash": 37.0, "minimum": 36.225, "maximum": 109.5203, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.64, "10th_percentile": 38.64, "90th_percentile": 38.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 109.52, "10th_percentile": 109.52, "90th_percentile": 110.61, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.64, "10th_percentile": 38.64, "90th_percentile": 38.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.64, "10th_percentile": 38.64, "90th_percentile": 38.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.05 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 96.65, "10th_percentile": 96.65, "90th_percentile": 96.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "1 through 10" } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC", "code_information": [ { "code": "843", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11591.0, "minimum": 11591.15, "maximum": 23516.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23516.66 } ] } ] }, { "description": "Corticosteriod Binding Globulin", "code_information": [ { "code": "84449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.5, "discounted_cash": 65.0, "minimum": 63.45, "maximum": 191.8305, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.79 } ] } ] }, { "description": "SHORT LEG SPLINT FAC", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.25, "discounted_cash": 70.0, "minimum": 68.175, "maximum": 206.1157, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.43, "10th_percentile": 97.43, "90th_percentile": 97.43, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.17, "10th_percentile": 74.17, "90th_percentile": 74.17, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 173.29, "10th_percentile": 173.29, "90th_percentile": 173.29, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 227.25, "10th_percentile": 216.5, "90th_percentile": 227.25, "count": "1 through 10" } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [ { "code": "668", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15454.0, "minimum": 15454.87, "maximum": 34423.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34423.82 } ] } ] }, { "description": "Legionella Ag, Urine", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 295.25, "discounted_cash": 91.0, "minimum": 73.3, "maximum": 267.7917, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 94.48, "10th_percentile": 94.48, "90th_percentile": 94.48, "count": "1 through 10" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "827", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 27246.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27246.69 } ] } ] }, { "description": "OTA MMT, Extremity, Trunk Units", "code_information": [ { "code": "95831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.5, "discounted_cash": 33.0, "minimum": 32.25, "maximum": 97.5025, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "von Willebrand Factor Antigen", "code_information": [ { "code": "85244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.0, "discounted_cash": 88.0, "minimum": 85.2, "maximum": 257.588, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 168.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 190.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.61 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 361.24, "10th_percentile": 361.24, "90th_percentile": 361.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 190.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 284.0, "10th_percentile": 284.0, "90th_percentile": 284.0, "count": "1 through 10" } ] } ] }, { "description": "Thiopurine Methyltransferase, RBC", "code_information": [ { "code": "83789", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1039.75, "discounted_cash": 322.0, "minimum": 115.54, "maximum": 943.0533, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.74 } ] } ] }, { "description": "Cortisol", "code_information": [ { "code": "82533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.75, "discounted_cash": 55.0, "minimum": 53.625, "maximum": 162.1262, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 80.44, "10th_percentile": 80.44, "90th_percentile": 80.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.34, "10th_percentile": 58.34, "90th_percentile": 58.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 113.69, "10th_percentile": 113.69, "90th_percentile": 227.38, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 143.07, "10th_percentile": 143.07, "90th_percentile": 143.07, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 185.25, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 171.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 162.13, "10th_percentile": 162.13, "90th_percentile": 162.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 57.2, "count": "1 through 10" } ] } ] }, { "description": "Phosphorus, Random Urine", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.75, "discounted_cash": 24.0, "minimum": 23.625, "maximum": 71.4262, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.2, "10th_percentile": 25.2, "90th_percentile": 25.2, "count": "1 through 10" } ] } ] }, { "description": "T-Cell Receptor TCRB Gene Rearrangement, PCR - 81340 - 3351273 - 3351273", "code_information": [ { "code": "81340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 820.0, "discounted_cash": 254.0, "minimum": 246.0, "maximum": 820.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 820.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 820.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 696.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 820.0 } ] } ] }, { "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": 5580.0, "minimum": 5580.93, "maximum": 21333.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21333.34 } ] } ] }, { "description": "VL Duplex Scan Venous Upper Bilat - Vascular US Charges", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1835.25, "discounted_cash": 568.0, "minimum": 550.575, "maximum": 1664.5718, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 751.73, "10th_percentile": 709.2, "90th_percentile": 751.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 857.03, "10th_percentile": 857.03, "90th_percentile": 1106.54, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1576.0, "10th_percentile": 1576.0, "90th_percentile": 1670.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 534.56, "10th_percentile": 504.32, "90th_percentile": 534.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 534.56, "10th_percentile": 534.56, "90th_percentile": 1515.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 534.56, "10th_percentile": 534.56, "90th_percentile": 534.56, "count": "1 through 10" } ] } ] }, { "description": "Factor XI Activity", "code_information": [ { "code": "85270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.75, "discounted_cash": 82.0, "minimum": 80.025, "maximum": 241.9423, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.86 } ] } ] }, { "description": "Bill IRL PreTx Serum Ea", "code_information": [ { "code": "86975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 717.5, "discounted_cash": 222.0, "minimum": 215.25, "maximum": 650.7725, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 350.21 } ] } ] }, { "description": "Electrical Stimulation Attended/15 min OT", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.75, "discounted_cash": 28.0, "minimum": 27.225, "maximum": 90.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.75 } ] } ] }, { "description": "Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 29.0, "minimum": 28.35, "maximum": 90.65, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "1 through 10" } ] } ] }, { "description": "88165 AP Bill Gyn Diag Path", "code_information": [ { "code": "88165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.5, "discounted_cash": 30.0, "minimum": 29.85, "maximum": 99.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.5 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITHOUT CCMCC", "code_information": [ { "code": "198", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 8443.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8443.27 } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH MCC", "code_information": [ { "code": "796", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7512.0, "minimum": 7512.79, "maximum": 13757.74, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13757.74 } ] } ] }, { "description": "SO EGFR Mutation", "code_information": [ { "code": "81235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2102.5, "discounted_cash": 651.0, "minimum": 630.75, "maximum": 2102.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2102.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2102.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1685.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2102.5 } ] } ] }, { "description": "XR Femur Right Min 2 Views", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.0, "discounted_cash": 106.0, "minimum": 103.5, "maximum": 312.915, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 182.82, "10th_percentile": 182.82, "90th_percentile": 228.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.61, "10th_percentile": 112.61, "90th_percentile": 112.61, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 282.55, "10th_percentile": 282.55, "90th_percentile": 282.55, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 260.53, "10th_percentile": 260.53, "90th_percentile": 260.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 325.5, "10th_percentile": 325.5, "90th_percentile": 345.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 106.95, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 104.16, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 104.16, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 104.16, "10th_percentile": 104.16, "90th_percentile": 104.16, "count": "1 through 10" } ] } ] }, { "description": "XR Ribs Bilateral wo Chest Film", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 551.0, "discounted_cash": 170.0, "minimum": 109.41, "maximum": 499.757, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 179.85, "10th_percentile": 179.85, "90th_percentile": 179.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 148.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.6 } ] } ] }, { "description": "XR Optic Foramina", "code_information": [ { "code": "70190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 694.75, "discounted_cash": 215.0, "minimum": 99.18, "maximum": 630.1382, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 134.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.39 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "394", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 15148.2333, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11030.95 } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH CC", "code_information": [ { "code": "549", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 52745.6417, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8748.09, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 29713.96, "10th_percentile": 29713.96, "90th_percentile": 29713.96, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14231.66 } ] } ] }, { "description": "AUARC - 86927 - 3001021", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 829.5, "discounted_cash": 257.0, "minimum": 219.4305, "maximum": 752.3565, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.43 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "757", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9873.0, "minimum": 9873.95, "maximum": 16880.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16880.64 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34558.0, "minimum": 34558.81, "maximum": 69905.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69905.11 } ] } ] }, { "description": "INT REP HAND FT <2.5 FAC", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 173.0, "minimum": 167.625, "maximum": 506.7862, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 438.79, "10th_percentile": 438.79, "90th_percentile": 438.79, "count": "1 through 10" } ] } ] }, { "description": "Triiodothyronine, Free (T3)", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.5, "discounted_cash": 54.0, "minimum": 52.95, "maximum": 160.0855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 117.37, "10th_percentile": 117.37, "90th_percentile": 117.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.43, "10th_percentile": 79.43, "90th_percentile": 79.43, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.61, "10th_percentile": 57.61, "90th_percentile": 57.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.4 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 112.25, "10th_percentile": 112.25, "90th_percentile": 112.25, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 138.61, "10th_percentile": 138.61, "90th_percentile": 141.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 176.5, "10th_percentile": 176.5, "90th_percentile": 176.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 176.5, "10th_percentile": 176.5, "90th_percentile": 176.5, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 56.48, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 161.67, "10th_percentile": 56.48, "90th_percentile": 161.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 56.48, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 56.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 56.48, "count": "1 through 10" } ] } ] }, { "description": "Antinuclear Antibody Screen", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.75, "discounted_cash": 47.0, "minimum": 45.825, "maximum": 138.5443, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 117.16, "10th_percentile": 111.46, "90th_percentile": 117.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.8, "10th_percentile": 64.8, "90th_percentile": 68.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.86, "10th_percentile": 49.86, "90th_percentile": 49.86, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.33 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 97.15, "10th_percentile": 97.15, "90th_percentile": 97.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 119.95, "10th_percentile": 119.95, "90th_percentile": 119.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 152.75, "10th_percentile": 144.0, "90th_percentile": 152.75, "count": "33" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.88, "10th_percentile": 46.08, "90th_percentile": 48.88, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.88, "10th_percentile": 48.88, "90th_percentile": 48.88, "count": "1 through 10" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 25236.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25236.67 } ] } ] }, { "description": "Acetaminophen IV Soln 10 MG/ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00264410090", "type": "NDC" }, { "code": "J0131", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 47.8, "10th_percentile": 47.8, "90th_percentile": 47.8, "count": "1 through 10" } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC", "code_information": [ { "code": "002", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18245.0, "minimum": 18245.34, "maximum": 133590.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 133590.36 } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [ { "code": "208", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10517.0, "minimum": 10517.9, "maximum": 32404.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32404.37 } ] } ] }, { "description": "PT Manual Therapy Units", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.25, "discounted_cash": 65.0, "minimum": 63.075, "maximum": 190.6968, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 18.77, "10th_percentile": 18.77, "90th_percentile": 18.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.28, "10th_percentile": 67.28, "90th_percentile": 283.77, "count": "1 through 10" } ] } ] }, { "description": "Homocysteine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.0, "discounted_cash": 80.0, "minimum": 78.3, "maximum": 236.727, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.52, "10th_percentile": 83.52, "90th_percentile": 83.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.52, "10th_percentile": 83.52, "90th_percentile": 83.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 85.19, "10th_percentile": 85.19, "90th_percentile": 85.19, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 261.0, "10th_percentile": 261.0, "90th_percentile": 261.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.52, "10th_percentile": 83.52, "90th_percentile": 83.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 239.08, "10th_percentile": 239.08, "90th_percentile": 239.08, "count": "1 through 10" } ] } ] }, { "description": "Blood type antigen donor ea", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.0, "discounted_cash": 60.0, "minimum": 23.57, "maximum": 175.958, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.19 } ] } ] }, { "description": "NM Myocardial Spect Multi", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3984.25, "discounted_cash": 1235.0, "minimum": 1195.275, "maximum": 3613.7148, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1215.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1645.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1300.46, "10th_percentile": 1300.46, "90th_percentile": 1300.46, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1645.46 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 3188.99, "10th_percentile": 3188.99, "90th_percentile": 3188.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3037.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 2235.68, "10th_percentile": 1706.03, "90th_percentile": 2235.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 272.82, "10th_percentile": 271.42, "90th_percentile": 272.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1274.96, "10th_percentile": 1274.96, "90th_percentile": 1274.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 2218.45, "10th_percentile": 2152.82, "90th_percentile": 2235.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1274.96, "10th_percentile": 1274.96, "90th_percentile": 1274.96, "count": "1 through 10" } ] } ] }, { "description": "IV Infusion Each Addl up to 8 Hr", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.0, "discounted_cash": 100.0, "minimum": 97.2, "maximum": 293.868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 250.78, "10th_percentile": 248.51, "90th_percentile": 1242.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 437.4, "10th_percentile": 145.8, "90th_percentile": 583.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 211.51, "10th_percentile": 105.75, "90th_percentile": 317.26, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.92, "10th_percentile": 22.1, "90th_percentile": 657.49, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 646.38, "10th_percentile": 646.38, "90th_percentile": 646.38, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 324.0, "10th_percentile": 324.0, "90th_percentile": 2592.0, "count": "19" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 207.36, "10th_percentile": 103.68, "90th_percentile": 414.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 414.72, "10th_percentile": 293.87, "90th_percentile": 587.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 207.36, "10th_percentile": 103.68, "90th_percentile": 518.4, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 311.04, "10th_percentile": 103.68, "90th_percentile": 1244.16, "count": "1 through 10" } ] } ] }, { "description": "Heparin Sod (Porcine) in NaCl IV Soln 25000 Unit/500ML-0.45%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "63323051801", "type": "NDC" }, { "code": "J1644", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 15.49, "10th_percentile": 15.49, "90th_percentile": 75.59, "count": "1 through 10" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [ { "code": "868", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 26174.0019, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12155.62 } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 17981.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17981.73 } ] } ] }, { "description": "MRI Forearm Left w Contrast", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 669.0, "minimum": 647.7, "maximum": 2159.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 } ] } ] }, { "description": "PT Neuromuscular Reeducation Units", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 36.0, "minimum": 35.4, "maximum": 107.026, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.76, "10th_percentile": 37.76, "90th_percentile": 37.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 75.52, "10th_percentile": 75.52, "90th_percentile": 113.28, "count": "1 through 10" } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [ { "code": "351", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 17972.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17972.3 } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITHOUT CCMCC", "code_information": [ { "code": "621", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2575.0, "minimum": 2575.81, "maximum": 17782.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17782.5 } ] } ] }, { "description": "NM Liver+ Spleen Scan Static", "code_information": [ { "code": "78215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.25, "discounted_cash": 244.0, "minimum": 236.175, "maximum": 787.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 631.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 787.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 787.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 787.25 } ] } ] }, { "description": "Magnesium Sulfate IV Soln 2 GM/50ML (40 MG/ML)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "63323010603", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 57.91, "10th_percentile": 57.91, "90th_percentile": 173.72, "count": "1 through 10" } ] } ] }, { "description": "MRI Breast Right Post Clip 77046", "code_information": [ { "code": "77046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 988.25, "discounted_cash": 306.0, "minimum": 296.475, "maximum": 988.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.25 } ] } ] }, { "description": "Lysozyme (Muramidase)", "code_information": [ { "code": "85549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 13.0, "minimum": 13.5, "maximum": 45.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.0 } ] } ] }, { "description": "CT Lumbar Spine wo Contrast", "code_information": [ { "code": "72131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1903.75, "discounted_cash": 590.0, "minimum": 571.125, "maximum": 1726.7013, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 586.21, "10th_percentile": 586.21, "90th_percentile": 621.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1495.01, "10th_percentile": 1495.01, "90th_percentile": 1495.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 724.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 574.72, "10th_percentile": 574.72, "90th_percentile": 574.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1903.75, "10th_percentile": 1796.0, "90th_percentile": 1903.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 590.16, "10th_percentile": 574.72, "90th_percentile": 609.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 609.2, "10th_percentile": 609.2, "90th_percentile": 609.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 609.2, "10th_percentile": 574.72, "90th_percentile": 609.2, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9873.0, "minimum": 9873.95, "maximum": 24364.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24364.28 } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38422.0, "minimum": 38422.53, "maximum": 70067.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70067.8 } ] } ] }, { "description": "Hydromorphone HCl Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641615125", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 23.73, "10th_percentile": 23.73, "90th_percentile": 23.73, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 14.5, "10th_percentile": 13.81, "90th_percentile": 14.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "1 through 10" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 9215.6325, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7568.53 } ] } ] }, { "description": "HSV I/II Ab Screen, IgG", "code_information": [ { "code": "86694", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.0, "discounted_cash": 52.0, "minimum": 50.7, "maximum": 153.283, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 71.78, "10th_percentile": 71.78, "90th_percentile": 71.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.1 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 107.48, "10th_percentile": 107.48, "90th_percentile": 107.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 169.0, "10th_percentile": 169.0, "90th_percentile": 169.0, "count": "1 through 10" } ] } ] }, { "description": "Echo Doppler Limited", "code_information": [ { "code": "93321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 508.25, "discounted_cash": 157.0, "minimum": 152.475, "maximum": 460.9828, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 336.66, "10th_percentile": 336.66, "90th_percentile": 336.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 508.25, "10th_percentile": 508.25, "90th_percentile": 508.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 162.64, "10th_percentile": 162.64, "90th_percentile": 162.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.53, "10th_percentile": 32.53, "90th_percentile": 32.53, "count": "1 through 10" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 28181.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28181.56 } ] } ] }, { "description": "CT Angio Upper Ext LT w+wo Contrast", "code_information": [ { "code": "73206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1681.0, "discounted_cash": 521.0, "minimum": 504.3, "maximum": 1681.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 507.44, "10th_percentile": 507.44, "90th_percentile": 507.44, "count": "1 through 10" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "168", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 16108.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16108.46 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "825", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 15908.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15908.05 } ] } ] }, { "description": "Echo 2D Comprehensive w/Contrast - C8929 - 5001009", "code_information": [ { "code": "C8929", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.0, "minimum": 760.5, "maximum": 2299.245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1140.75, "10th_percentile": 1140.75, "90th_percentile": 1140.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 827.42, "10th_percentile": 827.42, "90th_percentile": 827.42, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.25, "10th_percentile": 671.02, "90th_percentile": 683.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 811.2, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 162.24, "10th_percentile": 25.0, "90th_percentile": 1023.45, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 811.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 376.71, "10th_percentile": 35.82, "90th_percentile": 811.2, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH CC", "code_information": [ { "code": "797", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 11793.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11793.7 } ] } ] }, { "description": "Manual Differential", "code_information": [ { "code": "85007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.25, "discounted_cash": 11.0, "minimum": 10.875, "maximum": 35.4221, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "count": "1 through 10" } ] } ] }, { "description": "Factor X Activity", "code_information": [ { "code": "85260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.75, "discounted_cash": 101.0, "minimum": 98.625, "maximum": 298.1762, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.86 } ] } ] }, { "description": "XR Thoracolumbar Spine AP+Lateral", "code_information": [ { "code": "72080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.75, "discounted_cash": 158.0, "minimum": 96.27, "maximum": 464.1572, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 154.48, "10th_percentile": 154.48, "90th_percentile": 154.48, "count": "1 through 10" } ] } ] }, { "description": "US Doppler Echocard Fetal Pulse", "code_information": [ { "code": "76827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.75, "discounted_cash": 202.0, "minimum": 176.52, "maximum": 593.8582, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 239.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 360.96 } ] } ] }, { "description": "CRP, High Sensitivity", "code_information": [ { "code": "86141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.5, "discounted_cash": 43.0, "minimum": 41.85, "maximum": 126.5265, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.92, "10th_percentile": 42.92, "90th_percentile": 45.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.85 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 105.25, "10th_percentile": 105.25, "90th_percentile": 105.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 131.5, "10th_percentile": 131.5, "90th_percentile": 139.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.64, "10th_percentile": 44.64, "90th_percentile": 44.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 42.08, "10th_percentile": 42.08, "90th_percentile": 42.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.08, "10th_percentile": 42.08, "90th_percentile": 44.64, "count": "1 through 10" } ] } ] }, { "description": "Echo Myocardial Strain Imaging", "code_information": [ { "code": "93356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 13.0, "minimum": 12.6, "maximum": 38.094, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 26.5, "10th_percentile": 26.5, "90th_percentile": 26.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.06, "10th_percentile": 13.06, "90th_percentile": 13.06, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 12.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1279.56, "10th_percentile": 1279.56, "90th_percentile": 1279.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 12.8, "count": "1 through 10" } ] } ] }, { "description": "Cytomegalovirus Qual. by PCR", "code_information": [ { "code": "87496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.0, "discounted_cash": 121.0, "minimum": 117.9, "maximum": 356.451, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09 } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "251", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 17618.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17618.63 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "854", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10517.0, "minimum": 10517.9, "maximum": 23555.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23555.56 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 6679.1398, "maximum": 12083.7, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 9618.79, "standard_charge_algorithm": "78.53% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8703.6, "10th_percentile": 8703.6, "90th_percentile": 8703.6, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12083.7 } ] } ] }, { "description": "MA NP OP Consult New L2", "code_information": [ { "code": "99202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.5, "discounted_cash": 43.0, "minimum": 42.15, "maximum": 127.4335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 96.92, "10th_percentile": 96.92, "90th_percentile": 96.92, "count": "1 through 10" } ] } ] }, { "description": "MRI Chest w Contrast", "code_information": [ { "code": "71551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 669.0, "minimum": 647.7, "maximum": 2159.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "167", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 21260.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21260.25 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 37147.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37147.08 } ] } ] }, { "description": "CT Angio Lower Ext LT w+wo Contrast", "code_information": [ { "code": "73706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1681.0, "discounted_cash": 521.0, "minimum": 504.3, "maximum": 1681.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1426.28, "10th_percentile": 1426.28, "90th_percentile": 1426.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1585.75, "10th_percentile": 1585.75, "90th_percentile": 1681.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 507.44, "10th_percentile": 507.44, "90th_percentile": 507.44, "count": "1 through 10" } ] } ] }, { "description": "SLP Swallow Dysfunction Oral Feed Units", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348.25, "discounted_cash": 107.0, "minimum": 95.0, "maximum": 315.8628, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 111.44, "10th_percentile": 111.44, "90th_percentile": 111.44, "count": "1 through 10" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CCMCC", "code_information": [ { "code": "734", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 25110.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25110.53 } ] } ] }, { "description": "Warfarin Sensitivity CY[2C9 and VKORC1 - 81227 - 3351124 - 3351124", "code_information": [ { "code": "81227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 627.5, "discounted_cash": 194.0, "minimum": 188.25, "maximum": 627.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 547.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 619.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 424.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 627.5 } ] } ] }, { "description": "Chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 11.0, "minimum": 11.325, "maximum": 37.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.99, "10th_percentile": 16.99, "90th_percentile": 16.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 37.75, "10th_percentile": 37.75, "90th_percentile": 37.75, "count": "1 through 10" } ] } ] }, { "description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC", "code_information": [ { "code": "862", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10732.0, "minimum": 10052.2674, "maximum": 21499.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21499.56 } ] } ] }, { "description": "XR Finger-s Min 2 Views", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.75, "discounted_cash": 97.0, "minimum": 86.08, "maximum": 285.4783, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 197.51, "10th_percentile": 197.51, "90th_percentile": 197.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 141.64, "10th_percentile": 133.65, "90th_percentile": 283.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 96.94, "10th_percentile": 96.94, "90th_percentile": 102.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 200.18, "10th_percentile": 200.18, "90th_percentile": 243.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 247.17, "10th_percentile": 247.17, "90th_percentile": 494.35, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 203.45, "10th_percentile": 203.45, "90th_percentile": 203.45, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 314.75, "10th_percentile": 297.0, "90th_percentile": 314.75, "count": "35" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 100.72, "10th_percentile": 95.04, "90th_percentile": 100.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 251.11, "10th_percentile": 95.04, "90th_percentile": 285.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 100.72, "10th_percentile": 95.04, "90th_percentile": 201.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 100.72, "10th_percentile": 100.72, "90th_percentile": 100.72, "count": "1 through 10" } ] } ] }, { "description": "ASP BLADDER W CATH FAC", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8352.75, "discounted_cash": 2589.0, "minimum": 2505.825, "maximum": 7575.9442, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 2672.88, "10th_percentile": 2672.88, "90th_percentile": 2672.88, "count": "1 through 10" } ] } ] }, { "description": "Estriol Level", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.5, "discounted_cash": 89.0, "minimum": 86.25, "maximum": 260.7625, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 211.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.4 } ] } ] }, { "description": "Reptilase Time (Patient)", "code_information": [ { "code": "85635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.0, "discounted_cash": 37.0, "minimum": 36.3, "maximum": 109.747, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.01 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.82 } ] } ] }, { "description": "Bill Chr Anal Per Bld Interpret", "code_information": [ { "code": "88291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.5, "discounted_cash": 94.0, "minimum": 91.35, "maximum": 304.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.5 } ] } ] }, { "description": "NM Myocardial Infarct Avid Image", "code_information": [ { "code": "78466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 634.0, "discounted_cash": 196.0, "minimum": 190.2, "maximum": 634.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 570.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 634.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 634.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.0 } ] } ] }, { "description": "XR Bone Survey Complete", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.25, "discounted_cash": 195.0, "minimum": 189.075, "maximum": 623.2284, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 290.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 393.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 393.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.23 } ] } ] }, { "description": "C diff NAT", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.75, "discounted_cash": 60.0, "minimum": 58.725, "maximum": 195.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 143.0, "10th_percentile": 143.0, "90th_percentile": 143.0, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 195.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.3, "10th_percentile": 60.3, "90th_percentile": 60.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 163.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 195.75, "10th_percentile": 184.75, "90th_percentile": 195.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.27, "10th_percentile": 37.27, "90th_percentile": 62.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 62.64, "10th_percentile": 59.12, "90th_percentile": 177.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 62.64, "10th_percentile": 59.12, "90th_percentile": 62.64, "count": "1 through 10" } ] } ] }, { "description": "IM Hormonal Antineoplastic", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.75, "discounted_cash": 129.0, "minimum": 125.625, "maximum": 379.8062, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 179.44, "10th_percentile": 179.44, "90th_percentile": 188.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 271.04, "10th_percentile": 271.04, "90th_percentile": 277.38, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 418.75, "10th_percentile": 418.75, "90th_percentile": 418.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 418.75, "10th_percentile": 418.75, "90th_percentile": 837.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 255.2, "10th_percentile": 127.6, "90th_percentile": 268.0, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.0, "10th_percentile": 25.52, "90th_percentile": 2920.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.0, "10th_percentile": 134.0, "90th_percentile": 134.0, "count": "1 through 10" } ] } ] }, { "description": "Bill TPMT Enzyme Quant HPLC for 6-MTG", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 867.5, "discounted_cash": 268.0, "minimum": 115.54, "maximum": 786.8225, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.54 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 590.2, "10th_percentile": 590.2, "90th_percentile": 590.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.56 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 277.6, "10th_percentile": 277.6, "90th_percentile": 320.0, "count": "1 through 10" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [ { "code": "958", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13952.0, "minimum": 13952.32, "maximum": 49677.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49677.58 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17172.0, "minimum": 17172.08, "maximum": 69184.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69184.81 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 28535.873, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 11439.81, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 20655.43, "10th_percentile": 20655.43, "90th_percentile": 20655.43, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 10947.2, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 21315.5, "10th_percentile": 21315.5, "90th_percentile": 21315.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28535.87, "standard_charge_algorithm": "90.7% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12789.3, "10th_percentile": 12789.3, "90th_percentile": 19012.77, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21985.27 } ] } ] }, { "description": "96367 IV INF NONCHEM EA", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.25, "discounted_cash": 79.0, "minimum": 76.875, "maximum": 232.4187, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 170.41, "10th_percentile": 170.41, "90th_percentile": 170.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 115.31, "10th_percentile": 115.31, "90th_percentile": 115.31, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 339.48, "10th_percentile": 169.74, "90th_percentile": 339.48, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 83.64, "10th_percentile": 83.64, "90th_percentile": 83.64, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 205.0, "10th_percentile": 205.0, "90th_percentile": 410.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 269.5, "10th_percentile": 256.25, "90th_percentile": 512.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 256.25, "10th_percentile": 256.25, "90th_percentile": 512.5, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 82.0, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 232.42, "10th_percentile": 82.0, "90th_percentile": 469.45, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.58, "10th_percentile": 64.82, "90th_percentile": 164.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 164.0, "count": "15" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 3882.3288, "maximum": 28983.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28983.21 } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "272", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 30097.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30097.27 } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "655", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 24952.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24952.56 } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "750", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 17398.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17398.18 } ] } ] }, { "description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [ { "code": "055", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 12020.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12020.04 } ] } ] }, { "description": "NONTRAUMATIC STUPOR AND COMA WITH MCC", "code_information": [ { "code": "080", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 21338.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21338.05 } ] } ] }, { "description": "Neutral Fat, Fecal", "code_information": [ { "code": "82705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.75, "discounted_cash": 43.0, "minimum": 32.55, "maximum": 128.5673, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.54 } ] } ] }, { "description": "77373 F SBRT TX DELV UP TO 5 FRACTNS", "code_information": [ { "code": "77373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10313.5, "discounted_cash": 3197.0, "minimum": 3094.05, "maximum": 9354.3445, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6055.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8199.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8199.73 } ] } ] }, { "description": "Renin", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.25, "discounted_cash": 80.0, "minimum": 77.475, "maximum": 234.2328, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 181.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.73 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 82.64, "10th_percentile": 82.64, "90th_percentile": 82.64, "count": "1 through 10" } ] } ] }, { "description": "XR Mastoids Complete 3 Views Ea Side", "code_information": [ { "code": "70130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 407.0, "discounted_cash": 126.0, "minimum": 122.1, "maximum": 389.1677, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 201.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 201.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 389.17 } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CCMCC", "code_information": [ { "code": "735", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 15862.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15862.07 } ] } ] }, { "description": "INTUBATE ENDOTRACHEAL FAC", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670.75, "discounted_cash": 207.0, "minimum": 201.225, "maximum": 608.3703, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 670.75, "10th_percentile": 670.75, "90th_percentile": 670.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 207.93, "10th_percentile": 207.93, "90th_percentile": 214.64, "count": "1 through 10" } ] } ] }, { "description": "76932 FAC US GDNC VASC ACCESS", "code_information": [ { "code": "76932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.25, "discounted_cash": 213.0, "minimum": 206.475, "maximum": 624.2428, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 250.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 339.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 507.6 } ] } ] }, { "description": "MRI Femur Left w Contrast", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 669.0, "minimum": 647.7, "maximum": 2159.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1649.76 } ] } ] }, { "description": "IR Drainage Cath Placement 75989", "code_information": [ { "code": "75989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2201.25, "discounted_cash": 682.0, "minimum": 336.98, "maximum": 1996.5338, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 456.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 456.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 482.26 } ] } ] }, { "description": "88172 AP Bill FNA Immediate read", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.0, "discounted_cash": 39.0, "minimum": 38.4, "maximum": 128.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.0 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 9438.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9438.26 } ] } ] }, { "description": "Ova and Parasites, Conc and Perm Smear", "code_information": [ { "code": "87209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 41.0, "minimum": 40.5, "maximum": 135.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 98.49, "10th_percentile": 98.49, "90th_percentile": 98.49, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.26, "10th_percentile": 57.26, "90th_percentile": 57.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.53, "10th_percentile": 41.53, "90th_percentile": 44.06, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.97 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 85.86, "10th_percentile": 85.86, "90th_percentile": 85.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 106.02, "10th_percentile": 106.02, "90th_percentile": 106.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 135.0, "10th_percentile": 127.25, "90th_percentile": 135.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.98, "10th_percentile": 17.98, "90th_percentile": 40.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 43.2, "10th_percentile": 43.2, "90th_percentile": 43.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 40.72, "10th_percentile": 40.72, "90th_percentile": 43.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.4, "10th_percentile": 86.4, "90th_percentile": 86.4, "count": "1 through 10" } ] } ] }, { "description": "Calprotectin, Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.0, "discounted_cash": 114.0, "minimum": 111.0, "maximum": 335.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 286.38, "10th_percentile": 286.38, "90th_percentile": 286.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 162.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 183.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.77, "10th_percentile": 120.77, "90th_percentile": 120.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 125.57 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 296.15, "10th_percentile": 296.15, "90th_percentile": 296.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 182.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.63, "10th_percentile": 19.63, "90th_percentile": 56.9, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 370.0, "10th_percentile": 370.0, "90th_percentile": 370.0, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.63, "10th_percentile": 19.63, "90th_percentile": 118.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 118.4, "10th_percentile": 118.4, "90th_percentile": 118.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.4, "10th_percentile": 118.4, "90th_percentile": 118.4, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 24786.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24786.33 } ] } ] }, { "description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "956", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 12664.41, "maximum": 44361.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44361.93 } ] } ] }, { "description": "Copper, Serum", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.0, "discounted_cash": 33.0, "minimum": 32.7, "maximum": 109.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 109.0, "10th_percentile": 109.0, "90th_percentile": 109.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 98.86, "10th_percentile": 98.86, "90th_percentile": 98.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.88, "10th_percentile": 34.88, "90th_percentile": 34.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.88, "10th_percentile": 34.88, "90th_percentile": 34.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.58, "10th_percentile": 35.58, "90th_percentile": 35.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.39 } ] } ] }, { "description": "PROSTATECTOMY WITH MCC", "code_information": [ { "code": "665", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15240.0, "minimum": 15240.22, "maximum": 36795.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36795.76 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "738", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 17312.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17312.12 } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "965", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 11087.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11087.54 } ] } ] }, { "description": "TRAUMATIC INJURY WITH MCC", "code_information": [ { "code": "913", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 19270.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19270.27 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [ { "code": "687", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 12352.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12352.49 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 17313.5235, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6280.68, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11931.03, "10th_percentile": 11931.03, "90th_percentile": 11931.03, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11816.09 } ] } ] }, { "description": "Transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.5, "discounted_cash": 55.0, "minimum": 53.25, "maximum": 160.9925, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 118.04, "10th_percentile": 118.04, "90th_percentile": 136.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.94, "10th_percentile": 57.94, "90th_percentile": 57.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.67 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 112.89, "10th_percentile": 112.89, "90th_percentile": 112.89, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 139.39, "10th_percentile": 139.39, "90th_percentile": 139.39, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 177.5, "10th_percentile": 177.5, "90th_percentile": 177.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 177.5, "10th_percentile": 177.5, "90th_percentile": 177.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.8, "10th_percentile": 56.8, "90th_percentile": 56.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.8, "10th_percentile": 56.8, "90th_percentile": 56.8, "count": "1 through 10" } ] } ] }, { "description": "XR Foreign Body Child 1 View", "code_information": [ { "code": "76010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 349.5, "discounted_cash": 108.0, "minimum": 74.39, "maximum": 316.9965, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 329.75, "10th_percentile": 329.75, "90th_percentile": 349.5, "count": "1 through 10" } ] } ] }, { "description": "Paroxysmal Nocturnal Hemoglobinuria (PNH) with FLAER (High Sensitivity)", "code_information": [ { "code": "88184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 67.0, "minimum": 64.875, "maximum": 216.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.25 } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "331", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 19839.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19839.67 } ] } ] }, { "description": "HC (SUP SHELL C1776) JOINT DEVICE", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 1330.93, "10th_percentile": 1330.93, "90th_percentile": 1330.93, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12363.28, "10th_percentile": 12363.28, "90th_percentile": 12986.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 22143.97, "10th_percentile": 22143.97, "90th_percentile": 22143.97, "count": "1 through 10" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [ { "code": "908", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 23521.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23521.37 } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 9918.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9918.07 } ] } ] }, { "description": "75774 FAC ANGIOGRPHY SLCT EA AD VSL", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2456.0, "discounted_cash": 761.0, "minimum": 431.4448, "maximum": 2227.592, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 808.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1094.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1094.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.44 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [ { "code": "674", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 27569.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27569.71 } ] } ] }, { "description": "XR Upper Extremity Infant 2 Views Left", "code_information": [ { "code": "73092", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434.0, "discounted_cash": 134.0, "minimum": 78.79, "maximum": 393.638, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.05 } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "826", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18030.0, "minimum": 18030.68, "maximum": 55146.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55146.49 } ] } ] }, { "description": "SPLENIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "801", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 22503.98, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22503.98 } ] } ] }, { "description": "Rotavirus Antigen, Stool", "code_information": [ { "code": "87425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.25, "discounted_cash": 89.0, "minimum": 73.3, "maximum": 261.4427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 288.25, "10th_percentile": 288.25, "90th_percentile": 288.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.98, "10th_percentile": 11.98, "90th_percentile": 11.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 87.04, "10th_percentile": 87.04, "90th_percentile": 87.04, "count": "1 through 10" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 20357.6046, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 9645.33, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15546.4, "10th_percentile": 5716.68, "90th_percentile": 19154.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9229.99, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 19183.95, "10th_percentile": 19183.95, "90th_percentile": 19183.95, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 9229.99, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4859.92, "10th_percentile": 4859.92, "90th_percentile": 4859.92, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14025.35 } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CCMCC", "code_information": [ { "code": "807", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 7948.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7948.13 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CCMCC", "code_information": [ { "code": "742", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 21630.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21630.42 } ] } ] }, { "description": "Cystatin C, Serum", "code_information": [ { "code": "82610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.75, "discounted_cash": 83.0, "minimum": 72.6, "maximum": 242.8493, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 87.39, "10th_percentile": 87.39, "90th_percentile": 87.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 85.68, "10th_percentile": 85.68, "90th_percentile": 85.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 85.68, "10th_percentile": 85.68, "90th_percentile": 85.68, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 9263.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9263.78 } ] } ] }, { "description": "Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 38.0, "minimum": 37.125, "maximum": 112.2412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 94.92, "10th_percentile": 94.92, "90th_percentile": 94.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 55.69, "10th_percentile": 55.69, "90th_percentile": 55.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.45 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 99.05, "10th_percentile": 99.05, "90th_percentile": 99.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 123.75, "10th_percentile": 123.75, "90th_percentile": 123.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.6, "10th_percentile": 6.48, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 113.36, "10th_percentile": 113.36, "90th_percentile": 113.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" } ] } ] }, { "description": "SO KRAS Mutation Detect1", "code_information": [ { "code": "81275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.75, "discounted_cash": 210.0, "minimum": 203.325, "maximum": 677.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 677.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 677.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 677.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 677.75 } ] } ] }, { "description": "VIRAL MENINGITIS WITH CCMCC", "code_information": [ { "code": "075", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 22605.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22605.37 } ] } ] }, { "description": "88112 AP Bill Non-Gyn Cytology Liquid Prep", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.5, "discounted_cash": 42.0, "minimum": 40.65, "maximum": 135.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.5 } ] } ] }, { "description": "CT Head w Contrast", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1872.25, "discounted_cash": 580.0, "minimum": 561.675, "maximum": 1698.1308, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1230.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1230.63 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 837.55 } ] } ] }, { "description": "XR Surgical Specimen Breast", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.5, "discounted_cash": 66.0, "minimum": 46.68, "maximum": 215.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.5 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16957.0, "minimum": 16957.43, "maximum": 41490.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41490.14 } ] } ] }, { "description": "SEIZURES WITH MCC", "code_information": [ { "code": "100", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 22832.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22832.9 } ] } ] }, { "description": "BD DXA Bone Density Appendclr", "code_information": [ { "code": "77081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.25, "discounted_cash": 95.0, "minimum": 78.79, "maximum": 278.6757, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 138.26, "10th_percentile": 138.26, "90th_percentile": 138.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 94.57, "10th_percentile": 94.57, "90th_percentile": 100.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.69 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 241.28, "10th_percentile": 241.28, "90th_percentile": 241.28, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 289.75, "10th_percentile": 289.75, "90th_percentile": 307.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 92.72, "10th_percentile": 92.72, "90th_percentile": 98.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 92.72, "10th_percentile": 92.72, "90th_percentile": 98.32, "count": "1 through 10" } ] } ] }, { "description": "OSTEOMYELITIS WITH CC", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 15282.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15282.05 } ] } ] }, { "description": "Legionella pneumophila DFA", "code_information": [ { "code": "87278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.25, "discounted_cash": 59.0, "minimum": 57.375, "maximum": 173.4638, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.42 } ] } ] }, { "description": "CT Unlisted", "code_information": [ { "code": "76497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.0, "discounted_cash": 83.0, "minimum": 80.4, "maximum": 268.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.0 } ] } ] }, { "description": "CT Lumbar Spine w+wo Contrast", "code_information": [ { "code": "72133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2028.75, "discounted_cash": 628.0, "minimum": 608.625, "maximum": 1868.7, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1868.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1868.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1215.45 } ] } ] }, { "description": "VL Duplex Scan Venous Upper Unilateral - Vascular US Charges", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1293.75, "discounted_cash": 401.0, "minimum": 388.125, "maximum": 1173.4313, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 813.28, "10th_percentile": 813.28, "90th_percentile": 813.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 501.19, "10th_percentile": 472.84, "90th_percentile": 501.19, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 714.2, "10th_percentile": 590.18, "90th_percentile": 737.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 363.53, "10th_percentile": 342.96, "90th_percentile": 363.53, "count": "14" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 860.56, "10th_percentile": 860.56, "90th_percentile": 912.16, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 841.02, "10th_percentile": 841.02, "90th_percentile": 841.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 838.29, "10th_percentile": 838.29, "90th_percentile": 888.55, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 336.24, "10th_percentile": 14.6, "90th_percentile": 356.4, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 854.25, "10th_percentile": 854.25, "90th_percentile": 854.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1113.75, "10th_percentile": 1050.75, "90th_percentile": 1113.75, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 345.26, "10th_percentile": 336.24, "90th_percentile": 356.4, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 356.4, "10th_percentile": 356.4, "90th_percentile": 356.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 336.24, "10th_percentile": 25.0, "90th_percentile": 356.4, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 336.24, "10th_percentile": 336.24, "90th_percentile": 356.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 336.24, "10th_percentile": 336.24, "90th_percentile": 356.4, "count": "1 through 10" } ] } ] }, { "description": "BURN TX SM FAC", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.5, "discounted_cash": 81.0, "minimum": 79.35, "maximum": 239.9015, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 264.5, "10th_percentile": 264.5, "90th_percentile": 264.5, "count": "1 through 10" } ] } ] }, { "description": "Diabetic Ed Indiv 30 Min - G0108 - 1250135", "code_information": [ { "code": "G0108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.75, "minimum": 22.725, "maximum": 68.7053, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 185.85, "10th_percentile": 92.93, "90th_percentile": 185.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 218.85, "10th_percentile": 218.85, "90th_percentile": 273.57, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.4, "10th_percentile": 67.4, "90th_percentile": 67.4, "count": "15" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 676.49, "10th_percentile": 676.49, "90th_percentile": 676.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 329.49, "10th_percentile": 329.49, "90th_percentile": 329.49, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 66.08, "10th_percentile": 66.08, "90th_percentile": 132.16, "count": "14" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 36.66, "10th_percentile": 36.66, "90th_percentile": 73.32, "count": "19" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.03, "10th_percentile": 66.08, "90th_percentile": 132.16, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 132.16, "10th_percentile": 132.16, "90th_percentile": 132.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 66.08, "10th_percentile": 66.08, "90th_percentile": 132.16, "count": "17" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 132.16, "10th_percentile": 66.08, "90th_percentile": 132.16, "count": "1 through 10" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CCMCC", "code_information": [ { "code": "195", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4535.2656, "maximum": 7543.5281, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 4722.32, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4583.16, "10th_percentile": 4583.16, "90th_percentile": 4583.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 4722.32, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3064.0, "10th_percentile": 3064.0, "90th_percentile": 3064.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7409.37 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "517", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 18116.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18116.13 } ] } ] }, { "description": "Gastrin Level", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.25, "discounted_cash": 47.0, "minimum": 45.675, "maximum": 152.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.25 } ] } ] }, { "description": "XR Sacrum and Coccyx Min 2 Views", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 517.5, "discounted_cash": 160.0, "minimum": 83.16, "maximum": 469.3725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 219.71, "10th_percentile": 219.71, "90th_percentile": 219.71, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.61 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 390.8, "10th_percentile": 390.8, "90th_percentile": 390.8, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 488.25, "10th_percentile": 488.25, "90th_percentile": 517.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 165.6, "10th_percentile": 156.24, "90th_percentile": 165.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 447.24, "10th_percentile": 447.24, "90th_percentile": 447.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 165.6, "10th_percentile": 165.6, "90th_percentile": 165.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 165.6, "10th_percentile": 165.6, "90th_percentile": 165.6, "count": "1 through 10" } ] } ] }, { "description": "VEIN LIGATION AND STRIPPING", "code_information": [ { "code": "263", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 36043.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36043.63 } ] } ] }, { "description": "MRI Elbow Left w+wo Contrast", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "discounted_cash": 930.0, "minimum": 900.0, "maximum": 2951.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 2301.58, "10th_percentile": 2301.58, "90th_percentile": 2301.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2951.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2951.23 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.52 } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [ { "code": "320", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 28356.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28356.03 } ] } ] }, { "description": "N-Telopeptide Cross-Linked, Urine", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.5, "discounted_cash": 77.0, "minimum": 75.15, "maximum": 227.2035, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.28, "10th_percentile": 67.28, "90th_percentile": 67.28, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 9444.64, "maximum": 19445.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19445.92 } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CCMCC", "code_information": [ { "code": "063", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 16549.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16549.37 } ] } ] }, { "description": "Chemo IV Push Each Addl Subsequent", "code_information": [ { "code": "96411", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.0, "discounted_cash": 89.0, "minimum": 86.4, "maximum": 261.216, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 230.4, "10th_percentile": 230.4, "90th_percentile": 230.4, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 288.0, "10th_percentile": 274.25, "90th_percentile": 548.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 274.25, "10th_percentile": 274.25, "90th_percentile": 274.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 92.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 87.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 92.16, "count": "1 through 10" } ] } ] }, { "description": ".Beta 2 Glycoprotein IgG", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.5, "discounted_cash": 34.0, "minimum": 33.45, "maximum": 111.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 118.25, "10th_percentile": 118.25, "90th_percentile": 118.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.84, "10th_percentile": 37.84, "90th_percentile": 107.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.68, "10th_percentile": 35.68, "90th_percentile": 35.68, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23611.0, "minimum": 23611.61, "maximum": 90129.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 90129.11 } ] } ] }, { "description": "MRI Shoulder Left wo Contrast", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2134.75, "discounted_cash": 661.0, "minimum": 640.425, "maximum": 1936.2182, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1652.3, "10th_percentile": 1652.3, "90th_percentile": 1652.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 960.64, "10th_percentile": 960.64, "90th_percentile": 960.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 696.78, "10th_percentile": 696.78, "90th_percentile": 696.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1708.65, "10th_percentile": 1511.51, "90th_percentile": 1708.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1226.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2134.75, "10th_percentile": 1924.75, "90th_percentile": 2134.75, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 661.77, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" } ] } ] }, { "description": "Chloride, Stool", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.25, "discounted_cash": 23.0, "minimum": 22.575, "maximum": 68.2518, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.61 } ] } ] }, { "description": "Oxalic Acid/Creat Ratio", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.25, "discounted_cash": 52.0, "minimum": 50.775, "maximum": 153.5097, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.7 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "959", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 34707.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34707.94 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26616.0, "minimum": 26616.72, "maximum": 84558.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84558.82 } ] } ] }, { "description": "CT Liver RF Ablation 47382", "code_information": [ { "code": "47382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18977.5, "discounted_cash": 5883.0, "minimum": 650.0, "maximum": 17212.5925, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "T. Prot", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.0, "discounted_cash": 25.0, "minimum": 23.44, "maximum": 73.467, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 38.35, "10th_percentile": 38.35, "90th_percentile": 38.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.32, "10th_percentile": 16.32, "90th_percentile": 16.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 31.8, "10th_percentile": 31.8, "90th_percentile": 31.8, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.92, "10th_percentile": 3.67, "90th_percentile": 81.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 81.0, "10th_percentile": 50.0, "90th_percentile": 81.0, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 3.67, "10th_percentile": 3.67, "90th_percentile": 25.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 45.35, "10th_percentile": 45.35, "90th_percentile": 45.35, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "1 through 10" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "322", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 20783.97, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20783.97 } ] } ] }, { "description": "Clonazepam (Klonopin) Level - G0480 - 3358706", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.25, "minimum": 84.675, "maximum": 382.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 334.95, "10th_percentile": 133.46, "90th_percentile": 929.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 540.68, "10th_percentile": 78.3, "90th_percentile": 572.96, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 511.41, "10th_percentile": 495.07, "90th_percentile": 511.41, "count": "34" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 392.17, "10th_percentile": 56.79, "90th_percentile": 415.59, "count": "31" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 104.46, "10th_percentile": 104.46, "90th_percentile": 764.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 331.37, "10th_percentile": 131.47, "90th_percentile": 999.88, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 282.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 784.82, "10th_percentile": 164.25, "90th_percentile": 1151.05, "count": "46" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1201.5, "10th_percentile": 164.25, "90th_percentile": 1273.25, "count": "521" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.32, "10th_percentile": 52.56, "90th_percentile": 407.44, "count": "38" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 312.69, "10th_percentile": 312.69, "90th_percentile": 312.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 775.51, "10th_percentile": 261.27, "90th_percentile": 801.13, "count": "30" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 407.44, "10th_percentile": 384.48, "90th_percentile": 407.44, "count": "25" } ] } ] }, { "description": "US Abdomen Complete", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.5, "discounted_cash": 346.0, "minimum": 335.55, "maximum": 1014.4795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 503.33, "10th_percentile": 503.33, "90th_percentile": 503.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 519.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 365.08, "10th_percentile": 365.08, "90th_percentile": 365.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 519.49 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 711.37, "10th_percentile": 671.14, "90th_percentile": 711.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 878.36, "10th_percentile": 844.62, "90th_percentile": 878.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 665.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 337.68, "10th_percentile": 337.68, "90th_percentile": 337.68, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 701.74, "10th_percentile": 701.74, "90th_percentile": 701.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1118.5, "10th_percentile": 1055.25, "90th_percentile": 1118.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 357.92, "10th_percentile": 337.68, "90th_percentile": 357.92, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 966.61, "10th_percentile": 357.92, "90th_percentile": 1014.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 357.92, "10th_percentile": 357.92, "90th_percentile": 357.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 357.92, "10th_percentile": 357.92, "90th_percentile": 357.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 337.68, "10th_percentile": 337.68, "90th_percentile": 337.68, "count": "1 through 10" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [ { "code": "020", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18889.0, "minimum": 18889.29, "maximum": 92765.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 92765.13 } ] } ] }, { "description": "SEPTIC ARTHRITIS WITHOUT CCMCC", "code_information": [ { "code": "550", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 10304.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10304.75 } ] } ] }, { "description": "$ Thyroglobulin by CIA", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.0, "discounted_cash": 72.0, "minimum": 69.9, "maximum": 211.331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 154.95, "10th_percentile": 154.95, "90th_percentile": 154.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 132.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 241.0, "10th_percentile": 241.0, "90th_percentile": 241.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.56, "10th_percentile": 74.56, "90th_percentile": 74.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 426.86, "10th_percentile": 426.86, "90th_percentile": 426.86, "count": "1 through 10" } ] } ] }, { "description": "MRI Neck w Contrast", "code_information": [ { "code": "70542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1947.5, "discounted_cash": 603.0, "minimum": 584.25, "maximum": 1947.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1947.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1947.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1694.84 } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [ { "code": "808", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11161.0, "minimum": 4225.8351, "maximum": 26028.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26028.89 } ] } ] }, { "description": "Dexamethasone Sod Phosphate Preservative Free Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323050600", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 15.5, "10th_percentile": 15.5, "90th_percentile": 15.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 10.57, "10th_percentile": 10.57, "90th_percentile": 10.57, "count": "1 through 10" } ] } ] }, { "description": "Pregnenolone, LC/MS/MS", "code_information": [ { "code": "84140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.5, "discounted_cash": 26.0, "minimum": 25.65, "maximum": 85.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 85.5, "10th_percentile": 85.5, "90th_percentile": 85.5, "count": "1 through 10" } ] } ] }, { "description": "NM Cisternogram", "code_information": [ { "code": "78630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1027.0, "discounted_cash": 318.0, "minimum": 308.1, "maximum": 1027.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1027.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1027.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1027.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1027.0 } ] } ] }, { "description": "Debridement Nail Any Method 6 or Greater", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.5, "discounted_cash": 80.0, "minimum": 78.15, "maximum": 236.2735, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.71, "10th_percentile": 39.71, "90th_percentile": 39.71, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.24, "10th_percentile": 28.24, "90th_percentile": 28.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.2, "10th_percentile": 54.2, "90th_percentile": 54.2, "count": "1 through 10" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [ { "code": "580", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 8800.69, "maximum": 20371.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20371.36 } ] } ] }, { "description": "Bill IRL Enzyme Ea Cell", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 9.0, "minimum": 9.0, "maximum": 30.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 } ] } ] }, { "description": "Calcium Level", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.0, "discounted_cash": 8.0, "minimum": 8.7, "maximum": 29.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.05, "10th_percentile": 13.05, "90th_percentile": 13.05, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.47, "10th_percentile": 9.47, "90th_percentile": 9.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 18.44, "10th_percentile": 18.44, "90th_percentile": 18.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 29.0, "10th_percentile": 29.0, "90th_percentile": 29.0, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 26.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "count": "1 through 10" } ] } ] }, { "description": "Chg Smoking Cessation 3 - 10 minutes", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.75, "discounted_cash": 16.0, "minimum": 15.525, "maximum": 46.9372, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 5.18, "10th_percentile": 5.18, "90th_percentile": 5.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 3.75, "10th_percentile": 3.75, "90th_percentile": 3.75, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.5, "10th_percentile": 11.5, "90th_percentile": 11.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 11.5, "10th_percentile": 11.5, "90th_percentile": 11.5, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 3.68, "10th_percentile": 3.68, "90th_percentile": 3.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 0.74, "10th_percentile": 0.74, "90th_percentile": 3.68, "count": "13" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 3.68, "10th_percentile": 3.68, "90th_percentile": 3.68, "count": "1 through 10" } ] } ] }, { "description": "Digoxin", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.75, "discounted_cash": 44.0, "minimum": 42.825, "maximum": 129.4743, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 124.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.59, "10th_percentile": 46.59, "90th_percentile": 46.59, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 134.75, "10th_percentile": 134.75, "90th_percentile": 134.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.68, "10th_percentile": 45.68, "90th_percentile": 45.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.12, "10th_percentile": 43.12, "90th_percentile": 43.12, "count": "1 through 10" } ] } ] }, { "description": "Phenytoin Level", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.75, "discounted_cash": 49.0, "minimum": 47.925, "maximum": 144.8932, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.2, "10th_percentile": 49.2, "90th_percentile": 52.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.51 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.24, "10th_percentile": 48.24, "90th_percentile": 51.12, "count": "1 through 10" } ] } ] }, { "description": "CTA Head + Neck w+wo Contrast 70471", "code_information": [ { "code": "70471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1351.0, "discounted_cash": 418.0, "minimum": 405.3, "maximum": 1225.357, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "NM Bone Marrow Scan Limited", "code_information": [ { "code": "78102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.25, "discounted_cash": 202.0, "minimum": 196.275, "maximum": 654.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 526.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 654.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 654.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 654.25 } ] } ] }, { "description": "C1Q Binding Assay", "code_information": [ { "code": "86332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.75, "discounted_cash": 86.0, "minimum": 83.325, "maximum": 251.9193, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 201.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 227.17 } ] } ] }, { "description": "Theo", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.25, "discounted_cash": 47.0, "minimum": 46.275, "maximum": 139.9048, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 116.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 90.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.81 } ] } ] }, { "description": "US Hysterosonography", "code_information": [ { "code": "76831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 877.25, "discounted_cash": 271.0, "minimum": 263.175, "maximum": 795.6658, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 339.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 460.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 460.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 696.58 } ] } ] }, { "description": "IgG Subclass 1", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 20.0, "minimum": 19.8, "maximum": 66.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 158.36, "10th_percentile": 158.36, "90th_percentile": 158.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.68, "10th_percentile": 79.68, "90th_percentile": 79.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.68, "10th_percentile": 79.68, "90th_percentile": 79.68, "count": "1 through 10" } ] } ] }, { "description": "Stndrd Cog Perf Test HR 96125", "code_information": [ { "code": "96125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.25, "discounted_cash": 74.0, "minimum": 72.075, "maximum": 217.9067, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.48, "10th_percentile": 74.48, "90th_percentile": 74.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 153.76, "10th_percentile": 153.76, "90th_percentile": 153.76, "count": "1 through 10" } ] } ] }, { "description": "HLA-B*57:01 for Abacavir Sensitivity", "code_information": [ { "code": "81381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 667.25, "discounted_cash": 206.0, "minimum": 200.175, "maximum": 667.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 667.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 667.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 641.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.25 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 11188.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11188.92 } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CCMCC", "code_information": [ { "code": "804", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 15985.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15985.86 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 10896.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10896.55 } ] } ] }, { "description": "Stool Culture with Gram Stain", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 63.0, "minimum": 60.33, "maximum": 184.3477, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 148.41, "10th_percentile": 148.41, "90th_percentile": 157.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 62.59, "10th_percentile": 62.59, "90th_percentile": 62.59, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60.33 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 159.61, "10th_percentile": 159.61, "90th_percentile": 159.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 203.25, "10th_percentile": 191.75, "90th_percentile": 203.25, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 61.36, "10th_percentile": 9.44, "90th_percentile": 65.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 65.04, "10th_percentile": 65.04, "90th_percentile": 65.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 61.36, "10th_percentile": 61.36, "90th_percentile": 65.04, "count": "1 through 10" } ] } ] }, { "description": "PLEURAL EFFUSION WITH CC", "code_information": [ { "code": "187", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 11660.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11660.48 } ] } ] }, { "description": "Everolimus, Blood", "code_information": [ { "code": "80169", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 802.0, "discounted_cash": 248.0, "minimum": 43.6, "maximum": 727.414, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 261.77, "10th_percentile": 246.92, "90th_percentile": 261.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 256.64, "10th_percentile": 248.62, "90th_percentile": 256.64, "count": "1 through 10" } ] } ] }, { "description": "Rubella Antibody, IgG", "code_information": [ { "code": "86762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "discounted_cash": 28.0, "minimum": 27.375, "maximum": 91.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.07, "10th_percentile": 28.07, "90th_percentile": 29.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 54.7, "10th_percentile": 54.7, "90th_percentile": 58.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 86.0, "10th_percentile": 86.0, "90th_percentile": 86.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 29.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "1 through 10" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH CC", "code_information": [ { "code": "571", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10732.0, "minimum": 10732.55, "maximum": 19917.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19917.48 } ] } ] }, { "description": "Bill HIV GT Genotype", "code_information": [ { "code": "87901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1241.0, "discounted_cash": 384.0, "minimum": 372.3, "maximum": 1241.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 679.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 768.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 526.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1241.0 } ] } ] }, { "description": "Sedimentation Rate", "code_information": [ { "code": "85651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.5, "discounted_cash": 25.0, "minimum": 22.7, "maximum": 74.8275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 51.7, "10th_percentile": 51.7, "90th_percentile": 51.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.13, "10th_percentile": 34.99, "90th_percentile": 37.13, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.38, "10th_percentile": 25.38, "90th_percentile": 26.93, "count": "18" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 49.45, "10th_percentile": 49.45, "90th_percentile": 104.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 62.23, "10th_percentile": 62.23, "90th_percentile": 64.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 82.5, "10th_percentile": 77.75, "90th_percentile": 82.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 63.28, "10th_percentile": 51.7, "90th_percentile": 63.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 82.5, "count": "96" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.4, "count": "63" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 74.83, "10th_percentile": 24.88, "90th_percentile": 74.83, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.4, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.4, "count": "14" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.4, "count": "1 through 10" } ] } ] }, { "description": "Pinworm Prep", "code_information": [ { "code": "87172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.5, "discounted_cash": 21.0, "minimum": 20.85, "maximum": 63.0365, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.8 } ] } ] }, { "description": "IR Mech Removal Pericath OBS-CVAD", "code_information": [ { "code": "75901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1044.75, "discounted_cash": 323.0, "minimum": 313.425, "maximum": 1044.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 602.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 815.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1044.75 } ] } ] }, { "description": "IR Mech Removal Intracath OBS-CVAD", "code_information": [ { "code": "75902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1044.75, "discounted_cash": 323.0, "minimum": 313.425, "maximum": 947.5883, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 331.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 448.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 448.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.22 } ] } ] }, { "description": "Valproic", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 52.0, "minimum": 50.4, "maximum": 152.376, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 71.33, "10th_percentile": 71.33, "90th_percentile": 75.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.84, "10th_percentile": 54.84, "90th_percentile": 54.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 130.35, "10th_percentile": 130.35, "90th_percentile": 145.97, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 168.0, "10th_percentile": 158.5, "90th_percentile": 168.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.76, "10th_percentile": 50.72, "90th_percentile": 53.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.76, "10th_percentile": 53.76, "90th_percentile": 53.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.72, "10th_percentile": 50.72, "90th_percentile": 53.76, "count": "1 through 10" } ] } ] }, { "description": "PT Mechanical Traction Units", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.5, "discounted_cash": 29.0, "minimum": 28.65, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "XR Hand Left AP+Lateral", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.75, "discounted_cash": 75.0, "minimum": 73.125, "maximum": 221.0813, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 186.96, "10th_percentile": 186.96, "90th_percentile": 186.96, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.25 } ] } ] }, { "description": "ED US EXAM ABDO BACK WALL LIM FAC", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.25, "discounted_cash": 168.0, "minimum": 162.675, "maximum": 491.8207, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 465.83, "10th_percentile": 465.83, "90th_percentile": 465.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 442.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 442.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 276.34 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 465.83, "10th_percentile": 465.83, "90th_percentile": 465.83, "count": "1 through 10" } ] } ] }, { "description": "MRI Unlisted Procedure", "code_information": [ { "code": "76498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1779.0, "discounted_cash": 551.0, "minimum": 533.7, "maximum": 1613.553, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "OT Eval Low Complex", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.5, "discounted_cash": 155.0, "minimum": 95.0, "maximum": 454.8605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 225.68, "10th_percentile": 225.68, "90th_percentile": 225.68, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 69.39, "10th_percentile": 69.39, "90th_percentile": 69.39, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 3782.8584, "maximum": 9938.11, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 5549.76, "standard_charge_algorithm": "80% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12093.3, "10th_percentile": 12093.3, "90th_percentile": 12093.3, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 5580.93, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6874.74, "10th_percentile": 6874.74, "90th_percentile": 6874.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9938.11 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 37847.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37847.34 } ] } ] }, { "description": "Computer XM OK - XM Electronic Interp", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.0, "discounted_cash": 23.0, "minimum": 23.1, "maximum": 77.0, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.64, "10th_percentile": 24.64, "90th_percentile": 49.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.65, "10th_percentile": 34.65, "90th_percentile": 69.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.13, "10th_percentile": 25.13, "90th_percentile": 50.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 77.0, "10th_percentile": 77.0, "90th_percentile": 77.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.64, "10th_percentile": 24.64, "90th_percentile": 98.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 69.84, "10th_percentile": 69.84, "90th_percentile": 70.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.28, "10th_percentile": 24.64, "90th_percentile": 314.65, "count": "27" } ] } ] }, { "description": "CMV Antibody IgM", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.25, "discounted_cash": 89.0, "minimum": 87.075, "maximum": 263.2568, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 290.25, "10th_percentile": 290.25, "90th_percentile": 290.25, "count": "1 through 10" } ] } ] }, { "description": "CT SI Joint Nerve Inj 64451", "code_information": [ { "code": "64451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2406.75, "discounted_cash": 746.0, "minimum": 650.0, "maximum": 2182.9223, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "Urea Nitrogen, Random Urine", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.25, "discounted_cash": 20.0, "minimum": 20.175, "maximum": 60.9958, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.83 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 24961.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24961.99 } ] } ] }, { "description": "MRI Angio Neck w+wo Contrast", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2458.0, "discounted_cash": 761.0, "minimum": 737.4, "maximum": 2458.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2458.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2458.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2295.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 786.56, "10th_percentile": 786.56, "90th_percentile": 786.56, "count": "1 through 10" } ] } ] }, { "description": "CARDIOVERSION FAC", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1078.0, "discounted_cash": 334.0, "minimum": 323.4, "maximum": 977.746, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 485.1, "10th_percentile": 485.1, "90th_percentile": 485.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 351.86, "10th_percentile": 351.86, "90th_percentile": 351.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 846.55, "10th_percentile": 846.55, "90th_percentile": 846.55, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 344.96, "10th_percentile": 328.56, "90th_percentile": 344.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 977.75, "10th_percentile": 977.75, "90th_percentile": 977.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 344.96, "10th_percentile": 344.96, "90th_percentile": 344.96, "count": "1 through 10" } ] } ] }, { "description": "OTElectrical Stim (Unattended) - Non-Wound - 97014 - 4520006", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.5, "discounted_cash": 19.0, "minimum": 19.35, "maximum": 64.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.5 } ] } ] }, { "description": "TESTES PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "712", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 12964.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12964.34 } ] } ] }, { "description": "NM Myocardial SPECT Single", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3984.25, "discounted_cash": 1235.0, "minimum": 628.78, "maximum": 3613.7148, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 628.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 851.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 851.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2115.08 } ] } ] }, { "description": "CHEM CAUTERY TISSUE FAC", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 201.0, "minimum": 194.625, "maximum": 588.4162, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 207.6, "10th_percentile": 207.6, "90th_percentile": 207.6, "count": "1 through 10" } ] } ] }, { "description": "Gram positive identification (Vitek)", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 25.0, "minimum": 24.45, "maximum": 75.3185, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 62.51, "10th_percentile": 62.51, "90th_percentile": 62.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.68, "10th_percentile": 34.65, "90th_percentile": 36.68, "count": "18" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.6, "10th_percentile": 25.13, "90th_percentile": 53.2, "count": "25" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 51.83, "10th_percentile": 48.97, "90th_percentile": 65.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 64.0, "10th_percentile": 61.63, "90th_percentile": 64.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 77.0, "10th_percentile": 27.01, "90th_percentile": 154.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 81.5, "10th_percentile": 77.0, "90th_percentile": 81.5, "count": "61" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.08, "10th_percentile": 16.16, "90th_percentile": 49.28, "count": "80" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 75.32, "10th_percentile": 75.32, "90th_percentile": 75.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.08, "10th_percentile": 24.64, "90th_percentile": 52.16, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.64, "10th_percentile": 24.64, "90th_percentile": 24.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.08, "10th_percentile": 24.64, "90th_percentile": 26.08, "count": "1 through 10" } ] } ] }, { "description": "Aspergillus galactomannan Ag, Serum", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.5, "discounted_cash": 130.0, "minimum": 73.3, "maximum": 381.3935, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.67 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 27062.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27062.78 } ] } ] }, { "description": "OT Orthotic Management, Initial 15", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.25, "discounted_cash": 34.0, "minimum": 33.375, "maximum": 100.9038, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.6, "10th_percentile": 35.6, "90th_percentile": 35.6, "count": "1 through 10" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 29256.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29256.71 } ] } ] }, { "description": "XR Small Bowel Series", "code_information": [ { "code": "74250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1010.0, "discounted_cash": 313.0, "minimum": 303.0, "maximum": 916.07, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 307.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 416.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 416.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.65 } ] } ] }, { "description": "Quinidine Level", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 35.0, "minimum": 34.5, "maximum": 115.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 115.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.0 } ] } ] }, { "description": "FAC ART CATH SMPL TRN", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1880.0, "discounted_cash": 582.0, "minimum": 564.0, "maximum": 1705.16, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1880.0, "10th_percentile": 1880.0, "90th_percentile": 1880.0, "count": "1 through 10" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2575.0, "minimum": 2575.81, "maximum": 22903.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22903.63 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 77516.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77516.08 } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [ { "code": "273", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 48635.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48635.44 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 23580.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23580.32 } ] } ] }, { "description": "KIDNEY TRANSPLANT", "code_information": [ { "code": "652", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 38072.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38072.51 } ] } ] }, { "description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [ { "code": "792", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18459.0, "minimum": 18459.99, "maximum": 28873.57, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28873.57 } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 11319.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11319.78 } ] } ] }, { "description": "Fetal Screen", "code_information": [ { "code": "85461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.75, "discounted_cash": 71.0, "minimum": 42.46, "maximum": 209.2902, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.25 } ] } ] }, { "description": "EBV Capsid Ab, IgG", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.5, "discounted_cash": 55.0, "minimum": 54.15, "maximum": 169.0938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 226.43, "10th_percentile": 226.43, "90th_percentile": 226.43, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.44 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 272.54, "10th_percentile": 272.54, "90th_percentile": 272.54, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 340.5, "10th_percentile": 180.5, "90th_percentile": 361.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 115.52, "10th_percentile": 115.52, "90th_percentile": 115.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 201.74, "10th_percentile": 201.74, "90th_percentile": 201.74, "count": "1 through 10" } ] } ] }, { "description": "XR Bone Survey Limited", "code_information": [ { "code": "77076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.5, "discounted_cash": 85.0, "minimum": 82.65, "maximum": 275.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 275.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 275.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 275.5 } ] } ] }, { "description": "Aldosterone, Serum", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 464.5, "discounted_cash": 143.0, "minimum": 139.35, "maximum": 421.3015, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 260.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 379.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 464.5, "10th_percentile": 464.5, "90th_percentile": 464.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 148.64, "10th_percentile": 148.64, "90th_percentile": 148.64, "count": "1 through 10" } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 10077.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10077.22 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 19128.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19128.8 } ] } ] }, { "description": "% CD3", "code_information": [ { "code": "86359", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.25, "discounted_cash": 32.0, "minimum": 31.875, "maximum": 106.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.72, "10th_percentile": 32.72, "90th_percentile": 32.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 100.25, "10th_percentile": 100.25, "90th_percentile": 100.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.0, "10th_percentile": 34.0, "90th_percentile": 34.0, "count": "1 through 10" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 10465.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10465.08 } ] } ] }, { "description": "zzMaternal Serum Screen, Integrated Spec 1", "code_information": [ { "code": "84163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.75, "discounted_cash": 62.0, "minimum": 60.225, "maximum": 182.0803, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.29 } ] } ] }, { "description": "B-Cell Receptor IGH Gene Rearrangement, PCR", "code_information": [ { "code": "81261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 700.0, "discounted_cash": 217.0, "minimum": 210.0, "maximum": 700.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 700.0 } ] } ] }, { "description": "Plethysmography Lung Volumes", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1180.25, "discounted_cash": 365.0, "minimum": 354.075, "maximum": 1070.4868, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 781.8, "10th_percentile": 781.8, "90th_percentile": 781.8, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 363.44, "10th_percentile": 363.44, "90th_percentile": 363.44, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11591.0, "minimum": 11591.15, "maximum": 28991.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28991.46 } ] } ] }, { "description": "US Intra-Operative", "code_information": [ { "code": "76998", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603.75, "discounted_cash": 187.0, "minimum": 181.125, "maximum": 547.6013, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 339.74 } ] } ] }, { "description": "HCV Genosure", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1081.25, "discounted_cash": 335.0, "minimum": 324.375, "maximum": 1081.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1075.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1081.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 833.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1081.25 } ] } ] }, { "description": "Crossmatch Immediate Spin Interpretation", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.5, "discounted_cash": 26.0, "minimum": 25.35, "maximum": 84.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.58, "10th_percentile": 27.58, "90th_percentile": 27.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 84.5, "10th_percentile": 84.5, "90th_percentile": 84.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.08, "10th_percentile": 27.04, "90th_percentile": 54.08, "count": "1 through 10" } ] } ] }, { "description": "88142 AP Bill Gyn Cytology Liquid Prep Dx", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.75, "discounted_cash": 45.0, "minimum": 43.725, "maximum": 145.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 96.92, "10th_percentile": 96.92, "90th_percentile": 96.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.59, "10th_percentile": 65.59, "90th_percentile": 65.59, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 47.57, "10th_percentile": 47.57, "90th_percentile": 47.57, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 129.6 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 92.7, "10th_percentile": 92.7, "90th_percentile": 92.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 116.66, "10th_percentile": 114.46, "90th_percentile": 116.66, "count": "15" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 112.81, "10th_percentile": 112.81, "90th_percentile": 112.81, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 145.75, "10th_percentile": 145.75, "90th_percentile": 145.75, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.64, "10th_percentile": 46.64, "90th_percentile": 46.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 132.2, "10th_percentile": 116.28, "90th_percentile": 133.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.64, "10th_percentile": 29.09, "90th_percentile": 216.89, "count": "1 through 10" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11161.0, "minimum": 11161.85, "maximum": 36176.5385, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 11161.85, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 51157.2, "10th_percentile": 51157.2, "90th_percentile": 51157.2, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20903.04 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 30599.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30599.48 } ] } ] }, { "description": "OT Biofeedback Training 1st 15min units", "code_information": [ { "code": "90912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.5, "discounted_cash": 46.0, "minimum": 45.15, "maximum": 136.5035, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "BIMALL ANKLE FX MANI FAC", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 448.0, "discounted_cash": 138.0, "minimum": 134.4, "maximum": 406.336, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 366.9, "10th_percentile": 366.9, "90th_percentile": 366.9, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [ { "code": "806", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 8888.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8888.89 } ] } ] }, { "description": "Tetanus Ab, IgG", "code_information": [ { "code": "86774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.75, "discounted_cash": 53.0, "minimum": 51.825, "maximum": 156.6842, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.96 } ] } ] }, { "description": "VIRAL ILLNESS WITH MCC", "code_information": [ { "code": "865", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 1556.3789, "maximum": 17663.43, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8586.04, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2291.58, "10th_percentile": 2291.58, "90th_percentile": 2291.58, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17663.43 } ] } ] }, { "description": "MA Galactogram Single Duct Right Digital", "code_information": [ { "code": "77053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.5, "discounted_cash": 132.0, "minimum": 127.95, "maximum": 386.8355, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 236.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 320.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 320.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 313.01 } ] } ] }, { "description": "Hemoglobin A1C", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.5, "discounted_cash": 43.0, "minimum": 42.45, "maximum": 128.3405, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 141.5, "10th_percentile": 23.52, "90th_percentile": 141.5, "count": "98" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 94.1, "10th_percentile": 27.35, "90th_percentile": 108.53, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 141.5, "10th_percentile": 141.5, "90th_percentile": 141.5, "count": "340" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 45.28, "count": "349" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 128.34, "10th_percentile": 45.28, "90th_percentile": 129.61, "count": "61" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 45.28, "count": "227" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 45.28, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 45.28, "count": "55" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 94.1, "10th_percentile": 94.1, "90th_percentile": 94.1, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.68, "10th_percentile": 63.68, "90th_percentile": 63.68, "count": "111" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.19, "10th_percentile": 46.19, "90th_percentile": 46.19, "count": "99" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.09 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 89.99, "10th_percentile": 89.99, "90th_percentile": 89.99, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 113.26, "10th_percentile": 111.12, "90th_percentile": 113.26, "count": "38" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.51 } ] } ] }, { "description": "US Infant Hips Dynamic", "code_information": [ { "code": "76885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.5, "discounted_cash": 111.0, "minimum": 107.85, "maximum": 359.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 359.5 } ] } ] }, { "description": "MRI Thoracic Spine w+wo Contrast", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2556.5, "discounted_cash": 792.0, "minimum": 766.95, "maximum": 2556.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2556.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2556.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1880.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2556.5, "10th_percentile": 2556.5, "90th_percentile": 2556.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 818.08, "10th_percentile": 818.08, "90th_percentile": 818.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 818.08, "10th_percentile": 818.08, "90th_percentile": 818.08, "count": "1 through 10" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITH CCMCC", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 8800.69, "maximum": 78885.7536, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21353.38 } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITHOUT CCMCC", "code_information": [ { "code": "053", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 11543.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11543.77 } ] } ] }, { "description": "MRI Lumbar Spine w Contrast", "code_information": [ { "code": "72149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2126.25, "discounted_cash": 659.0, "minimum": 637.875, "maximum": 2126.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2126.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2126.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1646.89 } ] } ] }, { "description": "Thyroid Stimulating Immunoglobulin", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 440.5, "discounted_cash": 136.0, "minimum": 132.15, "maximum": 440.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 337.86, "10th_percentile": 337.86, "90th_percentile": 337.86, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 440.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 143.78, "10th_percentile": 143.78, "90th_percentile": 143.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 325.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 440.5, "10th_percentile": 440.5, "90th_percentile": 440.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 140.96, "10th_percentile": 140.96, "90th_percentile": 140.96, "count": "1 through 10" } ] } ] }, { "description": "OTA MMT, Hand Units", "code_information": [ { "code": "95832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.75, "discounted_cash": 32.0, "minimum": 31.125, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 20796.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20796.94 } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "165", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 22566.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22566.47 } ] } ] }, { "description": "PANCREAS TRANSPLANT", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 12664.41, "maximum": 84594.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84594.18 } ] } ] }, { "description": "Lyme IgG, Western Blot", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.5, "discounted_cash": 34.0, "minimum": 33.45, "maximum": 111.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 99.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 223.0, "10th_percentile": 210.5, "90th_percentile": 223.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 71.36, "10th_percentile": 71.36, "90th_percentile": 71.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 71.36, "10th_percentile": 71.36, "90th_percentile": 71.36, "count": "1 through 10" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 8399.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8399.65 } ] } ] }, { "description": "OTElectrical Stim (Unattended) - Non-Wound - G0283 - 4520006", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.5, "minimum": 19.35, "maximum": 64.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.5 } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [ { "code": "521", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12879.0, "minimum": 12879.06, "maximum": 33836.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33836.73 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3005.0, "minimum": 3005.11, "maximum": 16354.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16354.85 } ] } ] }, { "description": "Amikacin Level", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.25, "discounted_cash": 36.0, "minimum": 35.775, "maximum": 119.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.25 } ] } ] }, { "description": "99292 - Critical Care Ea Addl 30 min", "code_information": [ { "code": "99292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1064.0, "discounted_cash": 329.0, "minimum": 319.2, "maximum": 965.048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 716.14, "10th_percentile": 716.14, "90th_percentile": 716.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 832.73, "10th_percentile": 832.73, "90th_percentile": 2081.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 2083.74, "10th_percentile": 2083.74, "90th_percentile": 2083.74, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 1742.83, "10th_percentile": 1742.83, "90th_percentile": 1742.83, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 925.25, "10th_percentile": 925.25, "90th_percentile": 2128.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1850.5, "10th_percentile": 1064.0, "90th_percentile": 5551.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 340.48, "10th_percentile": 340.48, "90th_percentile": 340.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2368.64, "10th_percentile": 2368.64, "90th_percentile": 2368.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 592.16, "10th_percentile": 592.16, "90th_percentile": 2368.64, "count": "1 through 10" } ] } ] }, { "description": "NM Thyroid Image w Uptake", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1016.25, "discounted_cash": 315.0, "minimum": 304.875, "maximum": 1016.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 938.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1016.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1016.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1016.25 } ] } ] }, { "description": "Myco. tb Amplified Direct Detection", "code_information": [ { "code": "87556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.0, "discounted_cash": 121.0, "minimum": 117.9, "maximum": 388.5243, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 388.52 } ] } ] }, { "description": "HC (SUP SHELL C1769) GUIDE WIRE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 293.46, "10th_percentile": 293.46, "90th_percentile": 293.46, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 230.96, "10th_percentile": 230.96, "90th_percentile": 230.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 444.5, "10th_percentile": 444.5, "90th_percentile": 444.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 234.8, "10th_percentile": 234.8, "90th_percentile": 234.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2618.22, "10th_percentile": 2618.22, "90th_percentile": 2618.22, "count": "1 through 10" } ] } ] }, { "description": "74177 FAC CT ABD PELVIS W CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2767.25, "discounted_cash": 857.0, "minimum": 650.0, "maximum": 2509.8958, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1575.88, "10th_percentile": 1575.88, "90th_percentile": 1575.88, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1130.4, "10th_percentile": 1066.39, "90th_percentile": 1130.4, "count": "41" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1461.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 819.92, "10th_percentile": 773.49, "90th_percentile": 819.92, "count": "42" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1461.76 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1896.75, "10th_percentile": 1896.75, "90th_percentile": 1972.67, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1914.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 758.32, "10th_percentile": 384.37, "90th_percentile": 1529.16, "count": "25" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 468.54, "10th_percentile": 468.54, "90th_percentile": 1834.19, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2512.0, "10th_percentile": 2369.75, "90th_percentile": 2512.0, "count": "154" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 803.84, "count": "126" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2170.7, "10th_percentile": 803.84, "90th_percentile": 2278.38, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 803.84, "count": "75" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 758.32, "10th_percentile": 758.32, "90th_percentile": 803.84, "count": "43" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 803.84, "count": "16" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "595", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11591.0, "minimum": 11591.15, "maximum": 25000.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25000.89 } ] } ] }, { "description": "NM Myoview", "code_information": [ { "code": "A9502", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 367.5, "minimum": 110.25, "maximum": 367.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 367.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 226.36, "10th_percentile": 226.36, "90th_percentile": 226.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 310.95 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 555.08, "10th_percentile": 555.08, "90th_percentile": 555.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 367.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 693.5, "10th_percentile": 693.5, "90th_percentile": 693.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 221.92, "10th_percentile": 221.92, "90th_percentile": 221.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.38, "10th_percentile": 44.38, "90th_percentile": 44.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 117.6, "10th_percentile": 117.6, "90th_percentile": 221.92, "count": "1 through 10" } ] } ] }, { "description": "pH, Body Fluid", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.75, "discounted_cash": 19.0, "minimum": 18.825, "maximum": 56.9143, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.84, "10th_percentile": 13.84, "90th_percentile": 13.84, "count": "1 through 10" } ] } ] }, { "description": "99282 - Level 2 - Lynx Visit Level", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.5, "discounted_cash": 129.0, "minimum": 125.55, "maximum": 418.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 242.06, "10th_percentile": 242.06, "90th_percentile": 242.06, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 188.33, "10th_percentile": 163.8, "90th_percentile": 188.33, "count": "23" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 418.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 418.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.81, "10th_percentile": 118.81, "90th_percentile": 136.6, "count": "28" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 418.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 625.51, "10th_percentile": 625.51, "90th_percentile": 625.51, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 291.35, "10th_percentile": 291.35, "90th_percentile": 328.65, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 552.68, "10th_percentile": 290.4, "90th_percentile": 651.4, "count": "15" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 351.6, "count": "18" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 320.99, "10th_percentile": 320.99, "90th_percentile": 320.99, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 418.5, "10th_percentile": 364.0, "90th_percentile": 418.5, "count": "317" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "58" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 379.58, "10th_percentile": 379.58, "90th_percentile": 379.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "27" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "1 through 10" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "033", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 19603.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19603.89 } ] } ] }, { "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": 7942.0, "minimum": 7942.09, "maximum": 32075.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32075.46 } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT", "code_information": [ { "code": "469", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 35758.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35758.33 } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "903", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 13788.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13788.39 } ] } ] }, { "description": "Thyroxine, Free (FT4)", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.0, "discounted_cash": 62.0, "minimum": 57.7, "maximum": 183.214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 134.33, "10th_percentile": 134.33, "90th_percentile": 134.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.9, "10th_percentile": 90.9, "90th_percentile": 90.9, "count": "34" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.93, "10th_percentile": 65.93, "90th_percentile": 65.93, "count": "24" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 128.47, "10th_percentile": 128.47, "90th_percentile": 161.6, "count": "18" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 158.63, "10th_percentile": 158.63, "90th_percentile": 161.68, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 114.74, "10th_percentile": 27.94, "90th_percentile": 202.0, "count": "18" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 39.05, "10th_percentile": 39.05, "90th_percentile": 154.93, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 202.0, "10th_percentile": 202.0, "90th_percentile": 202.0, "count": "122" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "105" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 183.21, "10th_percentile": 64.64, "90th_percentile": 185.03, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "43" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L1830) KO IMMOB CANVAS LONG PRE OTS", "code_information": [ { "code": "L1830", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2.67, "10th_percentile": 2.67, "90th_percentile": 2.67, "count": "1 through 10" } ] } ] }, { "description": "CT Entire Upper Extrem RT W WO Contrast", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1606.5, "discounted_cash": 498.0, "minimum": 481.95, "maximum": 1606.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1606.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1606.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1606.5 } ] } ] }, { "description": "XR Lumbar Sp Bending 2-3V", "code_information": [ { "code": "72120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 554.5, "discounted_cash": 171.0, "minimum": 148.81, "maximum": 502.9315, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 249.53, "10th_percentile": 249.53, "90th_percentile": 249.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 201.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 201.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 253.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 177.44, "10th_percentile": 177.44, "90th_percentile": 207.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 554.5, "10th_percentile": 523.0, "90th_percentile": 554.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 177.44, "10th_percentile": 167.36, "90th_percentile": 177.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 177.44, "10th_percentile": 167.36, "90th_percentile": 327.03, "count": "1 through 10" } ] } ] }, { "description": "Methemoglobin", "code_information": [ { "code": "83050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.75, "discounted_cash": 35.0, "minimum": 34.125, "maximum": 103.1713, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.44 } ] } ] }, { "description": "XR Esophagram Single 74220", "code_information": [ { "code": "74220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.75, "discounted_cash": 292.0, "minimum": 252.36, "maximum": 855.9813, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 252.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 341.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 341.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.55 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 302.0, "10th_percentile": 302.0, "90th_percentile": 302.0, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 8524.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8524.61 } ] } ] }, { "description": "Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.5, "discounted_cash": 52.0, "minimum": 50.55, "maximum": 152.8295, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 112.05, "10th_percentile": 112.05, "90th_percentile": 112.05, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 75.83, "10th_percentile": 75.83, "90th_percentile": 75.83, "count": "56" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 55.0, "10th_percentile": 55.0, "90th_percentile": 55.0, "count": "45" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.15 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 107.17, "10th_percentile": 107.17, "90th_percentile": 107.17, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 132.32, "10th_percentile": 132.32, "90th_percentile": 134.87, "count": "30" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 146.58, "10th_percentile": 16.37, "90th_percentile": 168.5, "count": "15" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 112.05, "10th_percentile": 32.57, "90th_percentile": 129.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 168.5, "10th_percentile": 168.5, "90th_percentile": 168.5, "count": "201" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 53.92, "count": "186" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 152.83, "10th_percentile": 53.92, "90th_percentile": 154.35, "count": "39" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 53.92, "count": "112" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 53.92, "count": "16" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 53.92, "count": "14" } ] } ] }, { "description": "Cobalt, Serum/Plasma", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.75, "discounted_cash": 25.0, "minimum": 24.225, "maximum": 80.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.75 } ] } ] }, { "description": "Candida albicans Ab.IgG", "code_information": [ { "code": "86628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.0, "discounted_cash": 10.0, "minimum": 10.5, "maximum": 35.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.0 } ] } ] }, { "description": "NM Bone Scan Multiple", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 699.5, "discounted_cash": 216.0, "minimum": 209.85, "maximum": 699.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 699.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 699.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 699.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 699.5 } ] } ] }, { "description": "XR Skull Complete 4 Views", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 620.0, "discounted_cash": 192.0, "minimum": 124.02, "maximum": 562.34, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 167.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 620.0, "10th_percentile": 620.0, "90th_percentile": 620.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 187.2, "10th_percentile": 187.2, "90th_percentile": 187.2, "count": "1 through 10" } ] } ] }, { "description": "NM Bone Scan 3 Phase", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1415.25, "discounted_cash": 438.0, "minimum": 424.575, "maximum": 1415.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 994.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1347.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1347.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1415.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 438.73, "10th_percentile": 438.73, "90th_percentile": 438.73, "count": "1 through 10" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10517.0, "minimum": 1729.01, "maximum": 23203.07, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 10991.19, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 1878.43, "10th_percentile": 1878.43, "90th_percentile": 1878.43, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23203.07 } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 125 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009004703", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 42.86, "10th_percentile": 42.86, "90th_percentile": 42.86, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 52.1, "10th_percentile": 52.1, "90th_percentile": 52.1, "count": "1 through 10" } ] } ] }, { "description": "Urine Sodium", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.5, "discounted_cash": 15.0, "minimum": 15.15, "maximum": 47.1673, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 22.73, "10th_percentile": 22.73, "90th_percentile": 22.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.11 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 32.12, "10th_percentile": 32.12, "90th_percentile": 32.12, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.5, "10th_percentile": 50.5, "90th_percentile": 50.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 759.47, "10th_percentile": 759.47, "90th_percentile": 759.47, "count": "1 through 10" } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "465", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 21499.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21499.56 } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [ { "code": "552", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 11489.6073, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6224.88, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12789.3, "10th_percentile": 12789.3, "90th_percentile": 12789.3, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11332.75 } ] } ] }, { "description": "C. pneumoniae Antibody, IgG", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.75, "discounted_cash": 24.0, "minimum": 23.625, "maximum": 78.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.75 } ] } ] }, { "description": "CT Entire Upper Extrem LT WO Contrast", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1503.5, "discounted_cash": 466.0, "minimum": 451.05, "maximum": 1363.6745, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 418.61, "10th_percentile": 418.61, "90th_percentile": 418.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1007.15, "10th_percentile": 1007.15, "90th_percentile": 1007.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1210.0, "10th_percentile": 1210.0, "90th_percentile": 1282.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 410.4, "10th_percentile": 387.2, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" } ] } ] }, { "description": "CT Temp Bones w Contrast", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1804.5, "discounted_cash": 559.0, "minimum": 541.35, "maximum": 1685.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1685.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1685.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.56 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1652.92, "10th_percentile": 1652.92, "90th_percentile": 1652.92, "count": "1 through 10" } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [ { "code": "486", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 24651.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24651.94 } ] } ] }, { "description": "Procalcitonin", "code_information": [ { "code": "86352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.75, "discounted_cash": 106.0, "minimum": 103.125, "maximum": 343.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 215.63, "10th_percentile": 215.63, "90th_percentile": 215.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 145.91, "10th_percentile": 145.91, "90th_percentile": 154.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 343.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.2, "10th_percentile": 105.84, "90th_percentile": 112.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 343.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 275.0, "10th_percentile": 275.0, "90th_percentile": 275.0, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 259.53, "10th_percentile": 259.53, "90th_percentile": 269.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 343.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 324.25, "10th_percentile": 324.25, "90th_percentile": 343.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 343.75, "10th_percentile": 324.25, "90th_percentile": 343.75, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.76, "10th_percentile": 103.76, "90th_percentile": 110.0, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 110.0, "10th_percentile": 103.76, "90th_percentile": 274.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 110.0, "10th_percentile": 103.76, "90th_percentile": 110.0, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.76, "10th_percentile": 103.76, "90th_percentile": 110.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 110.0, "10th_percentile": 110.0, "90th_percentile": 110.0, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "724", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 7730.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7730.03 } ] } ] }, { "description": "Magnesium Sulfate IV Soln 20 GM/500ML (40 MG/ML)", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00409205001", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 57.91, "10th_percentile": 57.91, "90th_percentile": 173.72, "count": "1 through 10" } ] } ] }, { "description": "XR Calcaneous Right Min 2 Views", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.0, "discounted_cash": 115.0, "minimum": 72.93, "maximum": 337.404, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 372.0, "10th_percentile": 372.0, "90th_percentile": 372.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.04, "10th_percentile": 119.04, "90th_percentile": 119.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.32, "10th_percentile": 112.32, "90th_percentile": 112.32, "count": "1 through 10" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CCMCC", "code_information": [ { "code": "976", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 10641.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10641.91 } ] } ] }, { "description": "Natural Killer Cell Enumeration", "code_information": [ { "code": "86357", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.5, "discounted_cash": 77.0, "minimum": 73.3, "maximum": 248.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.83, "10th_percentile": 58.83, "90th_percentile": 58.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 180.25, "10th_percentile": 180.25, "90th_percentile": 180.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 61.12, "10th_percentile": 61.12, "90th_percentile": 61.12, "count": "1 through 10" } ] } ] }, { "description": "XR Eye Foreign Body Detect", "code_information": [ { "code": "70030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.0, "discounted_cash": 105.0, "minimum": 77.3, "maximum": 307.473, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.85 } ] } ] }, { "description": "Developmental Testing 1st Hr OT", "code_information": [ { "code": "96112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.5, "discounted_cash": 107.0, "minimum": 95.0, "maximum": 315.1825, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 6682.7224, "maximum": 16796.94, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 11115.4, "standard_charge_algorithm": "90.7% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6874.74, "10th_percentile": 6874.74, "90th_percentile": 6874.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16796.94 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 14993.7394, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6504.99, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9458.23, "10th_percentile": 9458.23, "90th_percentile": 9458.23, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10008.84 } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14810.0, "minimum": 14810.92, "maximum": 50283.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50283.54 } ] } ] }, { "description": "NM Inflamation Local Whole Body 78802", "code_information": [ { "code": "78802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5434.75, "discounted_cash": 1684.0, "minimum": 1101.43, "maximum": 4929.3183, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1101.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1491.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1491.39 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2072.74 } ] } ] }, { "description": "Angiotensin Converting Enzyme, Serum", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.75, "discounted_cash": 69.0, "minimum": 67.125, "maximum": 202.9412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 223.75, "10th_percentile": 223.75, "90th_percentile": 223.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 202.94, "10th_percentile": 202.94, "90th_percentile": 202.94, "count": "1 through 10" } ] } ] }, { "description": "XR Thoracic Spine w Swimmers", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 464.75, "discounted_cash": 144.0, "minimum": 109.41, "maximum": 421.5283, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 148.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.33 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 356.46, "10th_percentile": 356.46, "90th_percentile": 356.46, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CCMCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 2129.4674, "maximum": 8900.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8900.68 } ] } ] }, { "description": "Protein S Antigen, Total and Free", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.5, "discounted_cash": 17.0, "minimum": 16.65, "maximum": 55.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.5 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "373", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 8575.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8575.3 } ] } ] }, { "description": "CT Angiography Aorta Run Off w+wo Cont", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1849.25, "discounted_cash": 573.0, "minimum": 554.775, "maximum": 1849.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1849.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1849.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1849.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1849.25, "10th_percentile": 1849.25, "90th_percentile": 1849.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 591.76, "10th_percentile": 591.76, "90th_percentile": 591.76, "count": "1 through 10" } ] } ] }, { "description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [ { "code": "506", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 15905.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15905.69 } ] } ] }, { "description": "Ureaplasma/Mycoplasma hominis Culture", "code_information": [ { "code": "87109", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.25, "discounted_cash": 76.0, "minimum": 73.875, "maximum": 223.3487, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.46 } ] } ] }, { "description": "NM GE Reflux Scan", "code_information": [ { "code": "78262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.5, "discounted_cash": 273.0, "minimum": 265.05, "maximum": 883.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 809.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 883.5 } ] } ] }, { "description": "Thyroxine Binding Globulin", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.5, "discounted_cash": 52.0, "minimum": 50.55, "maximum": 152.8295, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.77 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 21914.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21914.53 } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [ { "code": "369", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 11791.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11791.34 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [ { "code": "673", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21894.0, "minimum": 21894.4, "maximum": 49532.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49532.58 } ] } ] }, { "description": "US Obstetrical Complete 14- Wk", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 774.0, "discounted_cash": 239.0, "minimum": 232.2, "maximum": 702.018, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 485.62, "10th_percentile": 485.62, "90th_percentile": 485.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 442.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 442.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 774.0, "10th_percentile": 730.25, "90th_percentile": 774.0, "count": "1 through 10" } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC", "code_information": [ { "code": "939", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13523.0, "minimum": 13523.01, "maximum": 42776.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42776.31 } ] } ] }, { "description": "Droperidol Inj 2.5 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00143951501", "type": "NDC" }, { "code": "J1790", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 14.5, "10th_percentile": 14.5, "90th_percentile": 25.05, "count": "1 through 10" } ] } ] }, { "description": "75833 FAC VENOGRAM RENAL BILATERAL", "code_information": [ { "code": "75833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7562.25, "discounted_cash": 2344.0, "minimum": 671.1743, "maximum": 6858.9608, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 895.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1212.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1212.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 671.17 } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "756", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 11323.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11323.32 } ] } ] }, { "description": "CT Elbow Left w Contrast", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1606.5, "discounted_cash": 498.0, "minimum": 481.95, "maximum": 1457.0955, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1449.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1449.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1283.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 484.96, "10th_percentile": 484.96, "90th_percentile": 484.96, "count": "1 through 10" } ] } ] }, { "description": "88368 AP Bill Manual Morph Analysis, Insitu Hybrid - 88368 - 3302012 - 3302012", "code_information": [ { "code": "88368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1494.5, "discounted_cash": 463.0, "minimum": 448.35, "maximum": 1355.5115, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1239.31 } ] } ] }, { "description": "XR Pyelogram Retrograde", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1540.0, "discounted_cash": 477.0, "minimum": 430.38, "maximum": 1396.78, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 430.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 582.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 582.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 456.85 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13093.0, "minimum": 13093.71, "maximum": 81083.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81083.43 } ] } ] }, { "description": "Cryoglobulin, Qual Reflex Qual IgA, G+M", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.5, "discounted_cash": 7.0, "minimum": 7.35, "maximum": 24.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 24.5, "10th_percentile": 24.5, "90th_percentile": 24.5, "count": "1 through 10" } ] } ] }, { "description": "U ALA", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 49.0, "minimum": 47.625, "maximum": 153.79, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.34 } ] } ] }, { "description": "XR Scoliosis 2 or 3 Views", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.25, "discounted_cash": 177.0, "minimum": 171.375, "maximum": 518.1237, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468.12 } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "270", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13523.0, "minimum": 13523.01, "maximum": 62202.2, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62202.2 } ] } ] }, { "description": "Trichomonas, Wet Mount", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.5, "discounted_cash": 21.0, "minimum": 21.15, "maximum": 63.9435, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 51.47, "10th_percentile": 51.47, "90th_percentile": 51.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 56.4, "10th_percentile": 56.4, "90th_percentile": 56.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 70.5, "10th_percentile": 66.5, "90th_percentile": 70.5, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 22.56, "10th_percentile": 22.56, "90th_percentile": 22.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 22.56, "10th_percentile": 22.56, "90th_percentile": 22.56, "count": "1 through 10" } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [ { "code": "543", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7512.0, "minimum": 1331.8407, "maximum": 12119.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12119.07 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 14672.1036, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 4936.97, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10657.75, "10th_percentile": 10657.75, "90th_percentile": 10657.75, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8673.15 } ] } ] }, { "description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15240.0, "minimum": 15240.22, "maximum": 54665.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54665.5 } ] } ] }, { "description": "SKIN ULCERS WITH CC", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9015.0, "minimum": 9015.34, "maximum": 29391.1955, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9015.34, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4263.1, "10th_percentile": 4263.1, "90th_percentile": 14920.85, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13985.27 } ] } ] }, { "description": "SLP Speech AAC Eval Addl Half Hour Units", "code_information": [ { "code": "92608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.75, "discounted_cash": 119.0, "minimum": 95.0, "maximum": 348.9683, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Transcut Bilirubin Test", "code_information": [ { "code": "88720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.25, "discounted_cash": 9.0, "minimum": 9.375, "maximum": 31.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 27.5, "10th_percentile": 27.5, "90th_percentile": 27.5, "count": "1 through 10" } ] } ] }, { "description": "Insulin Antibody", "code_information": [ { "code": "86337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.5, "discounted_cash": 99.0, "minimum": 96.15, "maximum": 290.6935, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 200.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.01 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 302.25, "10th_percentile": 302.25, "90th_percentile": 320.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 96.72, "10th_percentile": 96.72, "90th_percentile": 96.72, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [ { "code": "659", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12235.0, "minimum": 12235.11, "maximum": 29954.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29954.62 } ] } ] }, { "description": "SIM REP TRK <2.5 FAC", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.25, "discounted_cash": 107.0, "minimum": 103.575, "maximum": 313.1418, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 264.81, "10th_percentile": 264.81, "90th_percentile": 264.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 147.94, "10th_percentile": 147.94, "90th_percentile": 147.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 107.3, "10th_percentile": 107.3, "90th_percentile": 112.69, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 269.25, "10th_percentile": 269.25, "90th_percentile": 276.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 271.12, "10th_percentile": 263.13, "90th_percentile": 271.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 345.25, "10th_percentile": 328.75, "90th_percentile": 345.25, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 110.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 313.14, "10th_percentile": 275.44, "90th_percentile": 316.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 110.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 110.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 110.48, "10th_percentile": 110.48, "90th_percentile": 110.48, "count": "1 through 10" } ] } ] }, { "description": "Injection Therapy SC/IM", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.25, "discounted_cash": 41.0, "minimum": 40.575, "maximum": 122.6718, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 110.72, "10th_percentile": 110.72, "90th_percentile": 221.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.86, "10th_percentile": 26.21, "90th_percentile": 60.86, "count": "19" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 91.93, "10th_percentile": 71.67, "90th_percentile": 91.93, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.15, "10th_percentile": 19.01, "90th_percentile": 88.29, "count": "62" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 108.2, "10th_percentile": 108.2, "90th_percentile": 108.2, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 58.25, "count": "21" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 127.71, "10th_percentile": 127.71, "90th_percentile": 128.87, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 58.25, "10th_percentile": 58.25, "90th_percentile": 270.5, "count": "72" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 43.28, "count": "84" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 122.65, "10th_percentile": 43.28, "90th_percentile": 123.89, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.28, "10th_percentile": 18.64, "90th_percentile": 86.56, "count": "54" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.28, "10th_percentile": 43.28, "90th_percentile": 43.28, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.28, "10th_percentile": 43.28, "90th_percentile": 43.28, "count": "1 through 10" } ] } ] }, { "description": "URINARY STONES WITH MCC", "code_information": [ { "code": "693", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 15850.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15850.28 } ] } ] }, { "description": "LAC FACE 2.6-5CM FAC", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 123.0, "minimum": 119.4, "maximum": 360.986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 305.27, "10th_percentile": 305.27, "90th_percentile": 305.27, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 179.1, "10th_percentile": 179.1, "90th_percentile": 179.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 129.91, "10th_percentile": 129.91, "90th_percentile": 129.91, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 325.96, "10th_percentile": 325.96, "90th_percentile": 325.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 398.0, "10th_percentile": 398.0, "90th_percentile": 398.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.36, "10th_percentile": 127.36, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 360.99, "10th_percentile": 360.99, "90th_percentile": 360.99, "count": "1 through 10" } ] } ] }, { "description": "Imipramine Level", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 54.0, "minimum": 46.608, "maximum": 160.539, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.61 } ] } ] }, { "description": "MRI Non-conditional approval 76016", "code_information": [ { "code": "76016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.25, "discounted_cash": 81.0, "minimum": 79.275, "maximum": 264.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.25 } ] } ] }, { "description": "CSF Glucose", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.0, "discounted_cash": 17.0, "minimum": 17.1, "maximum": 51.699, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 57.0, "10th_percentile": 57.0, "90th_percentile": 57.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.24, "10th_percentile": 18.24, "90th_percentile": 18.24, "count": "1 through 10" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [ { "code": "012", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18459.0, "minimum": 18459.99, "maximum": 49702.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49702.34 } ] } ] }, { "description": "CT Angiography Pelvis w+wo Contrast", "code_information": [ { "code": "72191", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1825.75, "discounted_cash": 565.0, "minimum": 547.725, "maximum": 1825.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1825.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1825.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1825.75 } ] } ] }, { "description": "Prothrombin 20210 G/A Mutation by PCR", "code_information": [ { "code": "81240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.25, "discounted_cash": 45.0, "minimum": 44.175, "maximum": 147.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 147.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.25 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [ { "code": "690", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 13247.4142, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6280.68, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3239.71, "10th_percentile": 3239.71, "90th_percentile": 3239.71, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 6010.23, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15320.0, "10th_percentile": 15320.0, "90th_percentile": 15320.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9543.18 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 38347.19, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38347.19 } ] } ] }, { "description": "XR Video Swallowing Study", "code_information": [ { "code": "74230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 889.0, "discounted_cash": 275.0, "minimum": 247.99, "maximum": 843.2195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 649.19, "10th_percentile": 649.19, "90th_percentile": 649.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 400.05, "10th_percentile": 400.05, "90th_percentile": 400.05, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 247.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 273.77, "10th_percentile": 273.77, "90th_percentile": 290.17, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 335.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 843.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 420.56, "10th_percentile": 420.56, "90th_percentile": 420.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 838.75, "10th_percentile": 838.75, "90th_percentile": 889.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 284.48, "10th_percentile": 268.4, "90th_percentile": 284.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 268.4, "10th_percentile": 268.4, "90th_percentile": 268.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 284.48, "10th_percentile": 284.48, "90th_percentile": 284.48, "count": "1 through 10" } ] } ] }, { "description": "XR Mastoids 1-2 Views Ea Side", "code_information": [ { "code": "70120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 485.25, "discounted_cash": 150.0, "minimum": 96.27, "maximum": 440.1218, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.0 } ] } ] }, { "description": "ED US LMTD JT NONVASC XTR STRUX FAC", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.25, "discounted_cash": 133.0, "minimum": 59.26, "maximum": 389.3297, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 137.36, "10th_percentile": 137.36, "90th_percentile": 137.36, "count": "1 through 10" } ] } ] }, { "description": "Phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.0, "discounted_cash": 14.0, "minimum": 14.4, "maximum": 44.1844, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 31.92, "10th_percentile": 31.92, "90th_percentile": 31.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 21.6, "10th_percentile": 21.6, "90th_percentile": 21.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.67, "10th_percentile": 15.67, "90th_percentile": 15.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 30.53, "10th_percentile": 30.53, "90th_percentile": 30.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 38.42, "10th_percentile": 38.42, "90th_percentile": 38.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.0, "10th_percentile": 48.0, "90th_percentile": 48.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 48.0, "10th_percentile": 48.0, "90th_percentile": 48.0, "count": "42" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 15.36, "count": "104" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 43.54, "10th_percentile": 15.36, "90th_percentile": 43.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 15.36, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 15.36, "count": "22" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 15.36, "count": "1 through 10" } ] } ] }, { "description": "INT REP TRK 2.6-7.5 FAC", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1469.0, "discounted_cash": 455.0, "minimum": 440.7, "maximum": 1332.383, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1469.0, "10th_percentile": 1469.0, "90th_percentile": 1469.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 470.08, "10th_percentile": 470.08, "90th_percentile": 470.08, "count": "1 through 10" } ] } ] }, { "description": "Kappa/Lambda Light Chains, Free with Ratio, Random Urine", "code_information": [ { "code": "83521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 29.0, "minimum": 28.35, "maximum": 94.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.84, "10th_percentile": 30.84, "90th_percentile": 30.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.5 } ] } ] }, { "description": "Urinalysis with Sediment Exam", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.25, "discounted_cash": 18.0, "minimum": 17.475, "maximum": 52.8327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 38.74, "10th_percentile": 38.74, "90th_percentile": 38.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.21, "10th_percentile": 26.21, "90th_percentile": 26.21, "count": "63" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.01, "10th_percentile": 19.01, "90th_percentile": 19.01, "count": "68" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.29 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 46.6, "10th_percentile": 37.05, "90th_percentile": 47.71, "count": "26" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.25, "10th_percentile": 18.64, "90th_percentile": 58.25, "count": "17" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 44.68, "10th_percentile": 11.26, "90th_percentile": 45.09, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 58.25, "10th_percentile": 58.25, "90th_percentile": 58.25, "count": "274" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 3.17, "90th_percentile": 18.64, "count": "233" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 29.55, "10th_percentile": 29.55, "90th_percentile": 29.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 18.64, "count": "101" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 18.64, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 18.64, "count": "23" } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "727", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 17481.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17481.88 } ] } ] }, { "description": "Mycoplasma pneumoniae IgG", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.0, "discounted_cash": 75.0, "minimum": 66.77, "maximum": 220.401, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.42 } ] } ] }, { "description": "$ AP 88321 Consult", "code_information": [ { "code": "88321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1095.25, "discounted_cash": 339.0, "minimum": 328.575, "maximum": 1095.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1095.25 } ] } ] }, { "description": "CT Pelvis w Contrast", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1939.5, "discounted_cash": 601.0, "minimum": 581.85, "maximum": 1759.1265, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1453.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 597.23, "10th_percentile": 597.23, "90th_percentile": 633.05, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1453.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1528.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1829.75, "10th_percentile": 1829.75, "90th_percentile": 1939.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 601.25, "10th_percentile": 585.52, "90th_percentile": 620.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 585.52, "10th_percentile": 585.52, "90th_percentile": 585.52, "count": "1 through 10" } ] } ] }, { "description": "$ Streptozyme Titer", "code_information": [ { "code": "86406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.5, "discounted_cash": 24.0, "minimum": 23.55, "maximum": 78.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.5 } ] } ] }, { "description": "US Breast Right Limited", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.75, "discounted_cash": 151.0, "minimum": 146.925, "maximum": 448.3829, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 307.23, "10th_percentile": 307.23, "90th_percentile": 307.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 207.9, "10th_percentile": 207.9, "90th_percentile": 220.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 304.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 150.8, "10th_percentile": 150.8, "90th_percentile": 159.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.19 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 384.6, "10th_percentile": 369.78, "90th_percentile": 384.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 448.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 147.84, "10th_percentile": 147.84, "90th_percentile": 147.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 489.75, "10th_percentile": 462.0, "90th_percentile": 489.75, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 156.72, "10th_percentile": 147.84, "90th_percentile": 156.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 156.72, "10th_percentile": 147.84, "90th_percentile": 156.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 147.84, "10th_percentile": 147.84, "90th_percentile": 156.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 156.72, "10th_percentile": 156.72, "90th_percentile": 156.72, "count": "1 through 10" } ] } ] }, { "description": ".Antinuclear Abs Titer and Pattern", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.0, "discounted_cash": 11.0, "minimum": 11.1, "maximum": 37.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 27.09, "10th_percentile": 27.09, "90th_percentile": 28.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 23.53, "10th_percentile": 23.53, "90th_percentile": 23.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 29.06, "10th_percentile": 29.06, "90th_percentile": 29.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 35.0, "10th_percentile": 35.0, "90th_percentile": 37.0, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.2, "10th_percentile": 11.2, "90th_percentile": 11.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.2, "10th_percentile": 11.2, "90th_percentile": 11.84, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12020.0, "minimum": 12020.46, "maximum": 30753.3678, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22048.93 } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [ { "code": "327", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 28814.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28814.62 } ] } ] }, { "description": "US Soft Tissue Head Neck", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855.5, "discounted_cash": 265.0, "minimum": 256.65, "maximum": 775.9385, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 536.66, "10th_percentile": 536.66, "90th_percentile": 536.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 384.98, "10th_percentile": 363.15, "90th_percentile": 384.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 448.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 279.24, "10th_percentile": 263.4, "90th_percentile": 279.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 448.4 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 513.25, "10th_percentile": 513.25, "90th_percentile": 832.49, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 645.92, "10th_percentile": 645.92, "90th_percentile": 671.82, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 258.24, "10th_percentile": 258.24, "90th_percentile": 273.76, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 656.17, "10th_percentile": 656.17, "90th_percentile": 656.17, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 807.0, "10th_percentile": 807.0, "90th_percentile": 855.5, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 258.24, "10th_percentile": 258.24, "90th_percentile": 273.76, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 273.76, "10th_percentile": 273.76, "90th_percentile": 775.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 273.76, "10th_percentile": 258.24, "90th_percentile": 273.76, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 258.24, "10th_percentile": 258.24, "90th_percentile": 258.24, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 273.76, "10th_percentile": 273.76, "90th_percentile": 273.76, "count": "1 through 10" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM", "code_information": [ { "code": "173", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 35088.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35088.72 } ] } ] }, { "description": "I-D PERIANAL ABSCESS FAC", "code_information": [ { "code": "46050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2032.5, "discounted_cash": 630.0, "minimum": 609.75, "maximum": 1843.4775, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1935.75, "10th_percentile": 1935.75, "90th_percentile": 1935.75, "count": "1 through 10" } ] } ] }, { "description": "MRI Angio Neck w Contrast", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1744.5, "discounted_cash": 540.0, "minimum": 523.35, "maximum": 1744.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1744.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1548.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.16, "10th_percentile": 69.16, "90th_percentile": 1234.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 558.24, "10th_percentile": 558.24, "90th_percentile": 558.24, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 11303.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11303.27 } ] } ] }, { "description": "N-Terminal pro Brain Natriuretic Peptide", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.5, "discounted_cash": 165.0, "minimum": 160.35, "maximum": 484.7915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 355.44, "10th_percentile": 355.44, "90th_percentile": 355.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 240.53, "10th_percentile": 240.53, "90th_percentile": 240.53, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 174.46, "10th_percentile": 174.46, "90th_percentile": 174.46, "count": "28" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 217.15 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 339.94, "10th_percentile": 339.94, "90th_percentile": 437.76, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 419.74, "10th_percentile": 419.74, "90th_percentile": 427.81, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 342.88, "10th_percentile": 110.93, "90th_percentile": 534.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 413.7, "10th_percentile": 413.7, "90th_percentile": 413.7, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 534.5, "10th_percentile": 534.5, "90th_percentile": 534.5, "count": "53" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "85" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 484.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "49" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "22" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "1 through 10" } ] } ] }, { "description": "TX SHLDR DISLOC MANI FAC", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.75, "discounted_cash": 104.0, "minimum": 100.725, "maximum": 304.5253, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 274.98, "10th_percentile": 274.98, "90th_percentile": 274.98, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 319.75, "10th_percentile": 319.75, "90th_percentile": 335.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 292.89, "10th_percentile": 292.89, "90th_percentile": 304.53, "count": "1 through 10" } ] } ] }, { "description": "CT Neck w+wo Contrast", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2882.5, "discounted_cash": 893.0, "minimum": 650.0, "maximum": 2614.4275, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1815.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1815.35 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1280.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 870.16, "10th_percentile": 870.16, "90th_percentile": 870.16, "count": "1 through 10" } ] } ] }, { "description": "NM Hida Scan", "code_information": [ { "code": "78226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.0, "discounted_cash": 404.0, "minimum": 391.5, "maximum": 1305.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1186.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 425.95, "10th_percentile": 425.95, "90th_percentile": 425.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "819", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3434.0, "minimum": 3434.42, "maximum": 10137.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10137.34 } ] } ] }, { "description": "BD DXA Vertebral Fracture", "code_information": [ { "code": "77086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.5, "discounted_cash": 65.0, "minimum": 63.45, "maximum": 211.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 148.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.5 } ] } ] }, { "description": "B-Cell Receptor IGK Gene Rearrangement, PCR", "code_information": [ { "code": "81264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 700.0, "discounted_cash": 217.0, "minimum": 210.0, "maximum": 700.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 700.0 } ] } ] }, { "description": "Antibody Titer, Blood Bank", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.5, "discounted_cash": 74.0, "minimum": 33.12, "maximum": 217.2265, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.29 } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 18819.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18819.93 } ] } ] }, { "description": "REPLACE GTUBE PERCUT NO REV TRC FAC", "code_information": [ { "code": "43762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1041.5, "discounted_cash": 322.0, "minimum": 312.45, "maximum": 944.6405, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 317.44, "10th_percentile": 317.44, "90th_percentile": 333.28, "count": "1 through 10" } ] } ] }, { "description": "CT Head w+wo Contrast", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2254.5, "discounted_cash": 698.0, "minimum": 650.0, "maximum": 2044.8315, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1517.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 735.87, "10th_percentile": 735.87, "90th_percentile": 735.87, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1517.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1001.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2254.5, "10th_percentile": 2127.0, "90th_percentile": 2254.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 680.64, "10th_percentile": 680.64, "90th_percentile": 680.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 680.64, "10th_percentile": 680.64, "90th_percentile": 680.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 721.44, "10th_percentile": 721.44, "90th_percentile": 721.44, "count": "1 through 10" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 10725.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10725.61 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "845", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 10039.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10039.5 } ] } ] }, { "description": "XR Hip Right 2 or 3 Views w Pelvis", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.0, "discounted_cash": 106.0, "minimum": 103.5, "maximum": 313.0143, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 216.46, "10th_percentile": 216.46, "90th_percentile": 216.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 155.25, "10th_percentile": 146.48, "90th_percentile": 155.25, "count": "14" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 221.25, "10th_percentile": 182.82, "90th_percentile": 228.53, "count": "24" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.61, "10th_percentile": 106.24, "90th_percentile": 112.61, "count": "18" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 266.58, "10th_percentile": 266.58, "90th_percentile": 266.58, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 270.93, "10th_percentile": 270.93, "90th_percentile": 270.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 313.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 270.81, "10th_percentile": 104.16, "90th_percentile": 345.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 221.24, "10th_percentile": 221.24, "90th_percentile": 228.53, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 345.0, "10th_percentile": 325.5, "90th_percentile": 345.0, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 106.95, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "65" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 316.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 206.89, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 104.16, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "1 through 10" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 15697.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15697.03 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [ { "code": "564", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 18197.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18197.47 } ] } ] }, { "description": "NM Arthrogram", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 521.75, "discounted_cash": 161.0, "minimum": 156.525, "maximum": 521.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 521.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 521.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 521.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 521.75 } ] } ] }, { "description": "Cardiolipin Ab, IgG", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.0, "discounted_cash": 104.0, "minimum": 87.94, "maximum": 306.566, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 676.0, "10th_percentile": 676.0, "90th_percentile": 676.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 216.32, "10th_percentile": 216.32, "90th_percentile": 306.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 204.0, "10th_percentile": 204.0, "90th_percentile": 204.0, "count": "1 through 10" } ] } ] }, { "description": "zzU24 OHProl", "code_information": [ { "code": "83505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 383.75, "discounted_cash": 118.0, "minimum": 115.125, "maximum": 348.0612, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 155.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.51 } ] } ] }, { "description": "NM Cerebrospinal Imaging Ventriculograph", "code_information": [ { "code": "78635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 990.0, "discounted_cash": 306.0, "minimum": 297.0, "maximum": 990.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 990.0 } ] } ] }, { "description": "INJ ANES PERIPH NV FAC", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1318.25, "discounted_cash": 408.0, "minimum": 395.475, "maximum": 1195.6527, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 409.8, "10th_percentile": 409.8, "90th_percentile": 409.8, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1035.22, "10th_percentile": 1035.22, "90th_percentile": 1035.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 421.84, "10th_percentile": 421.84, "90th_percentile": 421.84, "count": "1 through 10" } ] } ] }, { "description": "XR Arthrogram TMJ", "code_information": [ { "code": "70332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1117.0, "discounted_cash": 346.0, "minimum": 231.93, "maximum": 1013.119, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 231.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 314.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 314.05 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.06 } ] } ] }, { "description": "Rapid Identification for Anaerobes WrkSht", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.5, "discounted_cash": 13.0, "minimum": 12.75, "maximum": 42.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "1 through 10" } ] } ] }, { "description": "XR Hip Bilateral w Pelvis 3 or 4 Views", "code_information": [ { "code": "73522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.25, "discounted_cash": 177.0, "minimum": 171.375, "maximum": 518.1237, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 366.36, "10th_percentile": 366.36, "90th_percentile": 388.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 175.93, "10th_percentile": 175.93, "90th_percentile": 186.46, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 363.32, "10th_percentile": 363.32, "90th_percentile": 363.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 338.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 539.0, "10th_percentile": 539.0, "90th_percentile": 571.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 172.48, "10th_percentile": 172.48, "90th_percentile": 182.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 182.8, "10th_percentile": 182.8, "90th_percentile": 182.8, "count": "1 through 10" } ] } ] }, { "description": "PTA Team Conference 30 Min Pt Present Unit", "code_information": [ { "code": "99366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.75, "discounted_cash": 42.0, "minimum": 40.725, "maximum": 123.1252, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "$ Hepatic Function Panel 80076", "code_information": [ { "code": "80076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.25, "discounted_cash": 71.0, "minimum": 52.27, "maximum": 207.9298, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 143.81, "10th_percentile": 143.81, "90th_percentile": 143.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.16, "10th_percentile": 97.31, "90th_percentile": 103.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.58, "10th_percentile": 70.58, "90th_percentile": 74.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.27 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 145.8, "10th_percentile": 145.8, "90th_percentile": 145.8, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 173.09, "10th_percentile": 173.09, "90th_percentile": 180.03, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 216.25, "10th_percentile": 182.96, "90th_percentile": 229.25, "count": "13" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 229.25, "10th_percentile": 216.25, "90th_percentile": 229.25, "count": "32" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.36, "10th_percentile": 69.2, "90th_percentile": 73.36, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 69.2, "10th_percentile": 69.2, "90th_percentile": 198.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.2, "10th_percentile": 69.2, "90th_percentile": 73.36, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.2, "10th_percentile": 69.2, "90th_percentile": 73.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.2, "10th_percentile": 69.2, "90th_percentile": 73.36, "count": "1 through 10" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [ { "code": "368", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 18766.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18766.88 } ] } ] }, { "description": "Vitamin B6 (Pyridoxal 5-Phosphate)", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.0, "discounted_cash": 159.0, "minimum": 154.5, "maximum": 467.105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 395.01, "10th_percentile": 395.01, "90th_percentile": 395.01, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 224.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 253.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 168.1, "10th_percentile": 168.1, "90th_percentile": 168.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 173.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 515.0, "10th_percentile": 515.0, "90th_percentile": 515.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 164.8, "10th_percentile": 164.8, "90th_percentile": 164.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 164.8, "10th_percentile": 164.8, "90th_percentile": 164.8, "count": "1 through 10" } ] } ] }, { "description": "RSV, PCR", "code_information": [ { "code": "87634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.75, "discounted_cash": 65.0, "minimum": 63.525, "maximum": 211.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 211.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 211.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 199.75, "10th_percentile": 199.75, "90th_percentile": 199.75, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.92, "10th_percentile": 63.92, "90th_percentile": 63.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 182.97, "10th_percentile": 182.97, "90th_percentile": 182.97, "count": "1 through 10" } ] } ] }, { "description": "Chemo Administration IV Push Single", "code_information": [ { "code": "96409", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.75, "discounted_cash": 129.0, "minimum": 125.625, "maximum": 379.8062, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 221.9, "10th_percentile": 221.9, "90th_percentile": 221.9, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 398.75, "10th_percentile": 398.75, "90th_percentile": 398.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 398.75, "10th_percentile": 398.75, "90th_percentile": 398.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.6, "10th_percentile": 127.6, "90th_percentile": 127.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.6, "10th_percentile": 127.6, "90th_percentile": 127.6, "count": "1 through 10" } ] } ] }, { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 7076.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7076.92 } ] } ] }, { "description": "XR Scoliosis 6 Views Min 72084", "code_information": [ { "code": "72084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 541.75, "discounted_cash": 167.0, "minimum": 162.525, "maximum": 541.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 541.75 } ] } ] }, { "description": "I-D ABSCESS COMPLEX FAC", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 173.0, "minimum": 167.625, "maximum": 506.7862, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 251.44, "10th_percentile": 251.44, "90th_percentile": 251.44, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 447.0, "10th_percentile": 447.0, "90th_percentile": 447.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 558.75, "10th_percentile": 558.75, "90th_percentile": 558.75, "count": "1 through 10" } ] } ] }, { "description": "Ionized Calcium", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.75, "discounted_cash": 58.0, "minimum": 56.625, "maximum": 171.1962, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 144.77, "10th_percentile": 144.77, "90th_percentile": 144.77, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 84.94, "10th_percentile": 84.94, "90th_percentile": 84.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 61.61, "10th_percentile": 61.61, "90th_percentile": 61.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.52 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 125.52, "10th_percentile": 125.52, "90th_percentile": 125.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 188.75, "10th_percentile": 188.75, "90th_percentile": 188.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.4, "10th_percentile": 60.4, "90th_percentile": 60.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 60.4, "10th_percentile": 60.4, "90th_percentile": 60.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.4, "10th_percentile": 60.4, "90th_percentile": 324.86, "count": "1 through 10" } ] } ] }, { "description": "US Spinal Canal", "code_information": [ { "code": "76800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 637.25, "discounted_cash": 197.0, "minimum": 191.175, "maximum": 637.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 373.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 373.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 637.25 } ] } ] }, { "description": "Parvovirus B19 Ab IgG", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.75, "discounted_cash": 125.0, "minimum": 59.54, "maximum": 368.0152, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.1 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "358", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 16479.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16479.82 } ] } ] }, { "description": "INS TEMP BLADDER CATHETER FAC", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.5, "discounted_cash": 121.0, "minimum": 117.45, "maximum": 355.0905, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.79, "10th_percentile": 127.79, "90th_percentile": 127.79, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.28, "10th_percentile": 119.28, "90th_percentile": 119.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 391.5, "10th_percentile": 372.75, "90th_percentile": 391.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.28, "10th_percentile": 119.28, "90th_percentile": 125.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 125.28, "10th_percentile": 125.28, "90th_percentile": 125.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 125.28, "10th_percentile": 125.28, "90th_percentile": 125.28, "count": "1 through 10" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "423", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17386.0, "minimum": 17386.73, "maximum": 48959.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48959.63 } ] } ] }, { "description": "Estrone, Serum", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.0, "discounted_cash": 35.0, "minimum": 34.8, "maximum": 116.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 116.0, "10th_percentile": 116.0, "90th_percentile": 116.0, "count": "1 through 10" } ] } ] }, { "description": "XR ERCP Biliary", "code_information": [ { "code": "74328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1545.75, "discounted_cash": 479.0, "minimum": 448.3829, "maximum": 1401.9952, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 701.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 701.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 448.38 } ] } ] }, { "description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [ { "code": "176", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 12487.8028, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 10812.21, "standard_charge_algorithm": "78.53% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11191.22, "10th_percentile": 11191.22, "90th_percentile": 11191.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 5151.62, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2315.0, "10th_percentile": 2315.0, "90th_percentile": 2315.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9490.13 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CCMCC", "code_information": [ { "code": "842", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 11911.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11911.59 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 14376.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14376.66 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 10013.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10013.56 } ] } ] }, { "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": 4078.0, "minimum": 4078.37, "maximum": 15833.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15833.78 } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CCMCC", "code_information": [ { "code": "941", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 23904.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23904.51 } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [ { "code": "922", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9015.0, "minimum": 9015.34, "maximum": 20623.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20623.64 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "816", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 7450.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7450.64 } ] } ] }, { "description": "Hepatitis B Surface Antigen - ECi", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.25, "discounted_cash": 33.0, "minimum": 32.775, "maximum": 99.0897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 64.01, "10th_percentile": 64.01, "90th_percentile": 64.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.31, "10th_percentile": 43.31, "90th_percentile": 43.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 69.48, "10th_percentile": 69.48, "90th_percentile": 69.48, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 77.04, "10th_percentile": 77.04, "90th_percentile": 77.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 109.25, "10th_percentile": 96.25, "90th_percentile": 109.25, "count": "34" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 88.16, "10th_percentile": 30.8, "90th_percentile": 99.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.96, "10th_percentile": 30.8, "90th_percentile": 34.96, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" } ] } ] }, { "description": "Hepatitis C Antibody, IgG", "code_information": [ { "code": "86803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.25, "discounted_cash": 65.0, "minimum": 63.375, "maximum": 191.6037, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 132.5, "10th_percentile": 132.5, "90th_percentile": 132.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 89.66, "10th_percentile": 89.66, "90th_percentile": 95.06, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.04, "10th_percentile": 65.04, "90th_percentile": 68.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.35 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 126.72, "10th_percentile": 126.72, "90th_percentile": 134.36, "count": "12" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 159.48, "10th_percentile": 159.48, "90th_percentile": 165.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.02 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 162.03, "10th_percentile": 162.03, "90th_percentile": 162.03, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 211.25, "10th_percentile": 199.25, "90th_percentile": 211.25, "count": "69" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.76, "10th_percentile": 63.76, "90th_percentile": 67.6, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 182.51, "10th_percentile": 67.6, "90th_percentile": 191.6, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.6, "10th_percentile": 63.76, "90th_percentile": 67.6, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.6, "10th_percentile": 67.6, "90th_percentile": 67.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.6, "10th_percentile": 67.6, "90th_percentile": 67.6, "count": "1 through 10" } ] } ] }, { "description": "88164 AP Bill Gyn Cytology w/o Pathologist Interpretation DX", "code_information": [ { "code": "88164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.5, "discounted_cash": 30.0, "minimum": 29.85, "maximum": 99.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.5 } ] } ] }, { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 21446.6408, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13214.27 } ] } ] }, { "description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4471.8035, "maximum": 8702.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8702.63 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23826.0, "minimum": 23826.26, "maximum": 58021.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58021.82 } ] } ] }, { "description": "XR Elbow Left Min 3 Views", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.75, "discounted_cash": 132.0, "minimum": 102.13, "maximum": 387.0623, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 311.54, "10th_percentile": 311.54, "90th_percentile": 330.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 181.13, "10th_percentile": 181.13, "90th_percentile": 192.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.38, "10th_percentile": 131.38, "90th_percentile": 139.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 138.29 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 271.41, "10th_percentile": 271.41, "90th_percentile": 271.41, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 335.13, "10th_percentile": 335.13, "90th_percentile": 335.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 206.55, "10th_percentile": 206.55, "90th_percentile": 426.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 402.5, "10th_percentile": 402.5, "90th_percentile": 426.75, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.8, "10th_percentile": 128.8, "90th_percentile": 136.56, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 368.69, "10th_percentile": 128.8, "90th_percentile": 368.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.56, "10th_percentile": 15.0, "90th_percentile": 403.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [ { "code": "204", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 9518.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9518.42 } ] } ] }, { "description": "HC (SUP SHELL C1781) MESH", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 679.75, "10th_percentile": 679.75, "90th_percentile": 679.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 436.56, "10th_percentile": 436.56, "90th_percentile": 1327.31, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 4066.5, "10th_percentile": 4066.5, "90th_percentile": 4066.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 410.88, "10th_percentile": 410.88, "90th_percentile": 410.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CCMCC", "code_information": [ { "code": "437", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 10059.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10059.54 } ] } ] }, { "description": "PT Needle Insertion WO Inj 1 or 2 Muscles Unit", "code_information": [ { "code": "20560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.5, "discounted_cash": 25.0, "minimum": 25.05, "maximum": 83.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.5 } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "574", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16313.0, "minimum": 16313.48, "maximum": 40924.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40924.27 } ] } ] }, { "description": "PT Physical Performance Test", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "discounted_cash": 51.0, "minimum": 49.875, "maximum": 150.7887, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [ { "code": "256", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10732.0, "minimum": 10732.55, "maximum": 20016.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20016.51 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13737.0, "minimum": 13737.66, "maximum": 53600.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53600.96 } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 25920.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25920.43 } ] } ] }, { "description": "Transfuse Blood", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1284.5, "discounted_cash": 398.0, "minimum": 385.35, "maximum": 1165.0415, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 550.46, "10th_percentile": 495.0, "90th_percentile": 578.03, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 419.26, "10th_percentile": 419.26, "90th_percentile": 419.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 1024.77, "10th_percentile": 1024.77, "90th_percentile": 1024.78, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1223.25, "10th_percentile": 1223.25, "90th_percentile": 1223.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 411.04, "10th_percentile": 391.44, "90th_percentile": 411.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1120.5, "10th_percentile": 1120.5, "90th_percentile": 1120.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 391.44, "10th_percentile": 391.44, "90th_percentile": 411.04, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 391.44, "10th_percentile": 391.44, "90th_percentile": 391.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 411.04, "10th_percentile": 411.04, "90th_percentile": 411.04, "count": "1 through 10" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11161.0, "minimum": 11161.85, "maximum": 20122.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20122.61 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "715", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10732.0, "minimum": 10732.55, "maximum": 26375.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26375.48 } ] } ] }, { "description": "XR Hip Bilateral w Pelvis 2 Views", "code_information": [ { "code": "73521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.25, "discounted_cash": 177.0, "minimum": 171.375, "maximum": 518.1237, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 378.4, "10th_percentile": 378.4, "90th_percentile": 378.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.47 } ] } ] }, { "description": "RPR Quantitative Titer", "code_information": [ { "code": "86593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.75, "discounted_cash": 20.0, "minimum": 19.725, "maximum": 59.6352, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 4.4, "10th_percentile": 4.4, "90th_percentile": 4.4, "count": "1 through 10" } ] } ] }, { "description": "PT Needle Insertion WO Inj 3+ Muscles Unit", "code_information": [ { "code": "20561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.5, "discounted_cash": 25.0, "minimum": 25.05, "maximum": 83.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.5 } ] } ] }, { "description": "IR Lymphangiogram Pelvic-Abd Bilat", "code_information": [ { "code": "75807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1581.75, "discounted_cash": 490.0, "minimum": 474.525, "maximum": 1581.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 974.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1319.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1319.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1581.75 } ] } ] }, { "description": "HIV Phenosense Entry", "code_information": [ { "code": "87903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2476.0, "discounted_cash": 767.0, "minimum": 742.8, "maximum": 2476.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2476.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2476.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2476.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2476.0 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 26294.9712, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6280.68, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 1392.54, "10th_percentile": 1392.54, "90th_percentile": 30738.97, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12152.08 } ] } ] }, { "description": "Chemo Administraion SC/IM Non Hormonal", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.75, "discounted_cash": 129.0, "minimum": 125.625, "maximum": 379.8062, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 277.38, "10th_percentile": 271.04, "90th_percentile": 277.38, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 398.75, "10th_percentile": 398.75, "90th_percentile": 398.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.0, "10th_percentile": 127.6, "90th_percentile": 134.0, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 127.6, "10th_percentile": 127.6, "90th_percentile": 127.6, "count": "1 through 10" } ] } ] }, { "description": "CT Limited Follow-up", "code_information": [ { "code": "76380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 641.25, "discounted_cash": 198.0, "minimum": 192.375, "maximum": 641.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 574.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 574.81 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 641.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 641.25 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 8115.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8115.53 } ] } ] }, { "description": "XR Cholangiogram w Fluoro in the OR", "code_information": [ { "code": "74300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.0, "discounted_cash": 314.0, "minimum": 138.58, "maximum": 919.698, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.05 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 3004.5812, "maximum": 23351.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23351.61 } ] } ] }, { "description": "JAK2 Exon 12 Mutation Anlysis", "code_information": [ { "code": "81279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 640.75, "discounted_cash": 198.0, "minimum": 192.225, "maximum": 640.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 163.04, "10th_percentile": 163.04, "90th_percentile": 205.04, "count": "1 through 10" } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [ { "code": "811", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 17967.5249, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16555.26 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 13336.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13336.87 } ] } ] }, { "description": "Iron Sucrose Inj 20 MG/ML (Fe Equiv)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00517231005", "type": "NDC" }, { "code": "J1756", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 259.19, "10th_percentile": 259.19, "90th_percentile": 259.19, "count": "1 through 10" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 17738.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17738.88 } ] } ] }, { "description": "KOH, Fluor", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.5, "discounted_cash": 32.0, "minimum": 31.05, "maximum": 93.8745, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.24 } ] } ] }, { "description": "Hepatitis Be Antigen", "code_information": [ { "code": "87350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.25, "discounted_cash": 33.0, "minimum": 32.775, "maximum": 107.67, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" } ] } ] }, { "description": "APC Resistance", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.25, "discounted_cash": 58.0, "minimum": 56.775, "maximum": 171.6498, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.81 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.12, "10th_percentile": 57.12, "90th_percentile": 57.12, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 11561.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11561.45 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2575.0, "minimum": 2575.81, "maximum": 13857.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13857.95 } ] } ] }, { "description": "NM Venous Thrombosis Unilateral", "code_information": [ { "code": "78457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 803.5, "discounted_cash": 249.0, "minimum": 241.05, "maximum": 803.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 593.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 803.5 } ] } ] }, { "description": "BhCG Quant", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.75, "discounted_cash": 51.0, "minimum": 50.025, "maximum": 151.2423, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 110.89, "10th_percentile": 110.89, "90th_percentile": 110.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.31 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 106.05, "10th_percentile": 106.05, "90th_percentile": 106.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 133.47, "10th_percentile": 130.95, "90th_percentile": 133.47, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.29 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 129.06, "10th_percentile": 129.06, "90th_percentile": 129.06, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 166.75, "count": "39" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 151.24, "10th_percentile": 151.24, "90th_percentile": 151.24, "count": "1 through 10" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3005.0, "minimum": 3005.11, "maximum": 16496.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16496.32 } ] } ] }, { "description": "XR Abdomen 1 View 74018", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 321.75, "discounted_cash": 99.0, "minimum": 74.26, "maximum": 291.8272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 234.91, "10th_percentile": 234.91, "90th_percentile": 246.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 144.79, "10th_percentile": 136.58, "90th_percentile": 144.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.02, "10th_percentile": 105.02, "90th_percentile": 105.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 151.82 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 193.03, "10th_percentile": 193.03, "90th_percentile": 248.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.12, "10th_percentile": 97.12, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 303.5, "10th_percentile": 303.5, "90th_percentile": 321.75, "count": "24" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.12, "10th_percentile": 97.12, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 97.12, "10th_percentile": 97.12, "90th_percentile": 291.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.12, "10th_percentile": 97.12, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.12, "10th_percentile": 97.12, "90th_percentile": 102.96, "count": "1 through 10" } ] } ] }, { "description": "Sodium Level", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 11.0, "minimum": 11.325, "maximum": 37.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.99, "10th_percentile": 16.99, "90th_percentile": 16.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.32, "10th_percentile": 12.32, "90th_percentile": 12.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.76 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 24.01, "10th_percentile": 24.01, "90th_percentile": 24.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.75, "10th_percentile": 37.75, "90th_percentile": 37.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 37.75, "10th_percentile": 37.75, "90th_percentile": 37.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" } ] } ] }, { "description": "75630 FAC AORTOGRAPHY LEG ART S&I", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8204.75, "discounted_cash": 2543.0, "minimum": 547.075, "maximum": 7441.7082, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 901.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1220.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1220.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.08 } ] } ] }, { "description": "HC (SUP SHELL C1726) CATHETER BALLOON DILAT NON-VASCULAR", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 576.53, "10th_percentile": 576.53, "90th_percentile": 1254.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 247.0, "10th_percentile": 247.0, "90th_percentile": 247.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1627.0, "10th_percentile": 1627.0, "90th_percentile": 1627.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 325.36, "10th_percentile": 318.96, "90th_percentile": 344.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 693.18, "10th_percentile": 693.18, "90th_percentile": 693.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "1 through 10" } ] } ] }, { "description": "Myoglobin, Urine", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 45.0, "minimum": 43.95, "maximum": 132.8755, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.44 } ] } ] }, { "description": "US Doppler Veloc Fetal Umbilical Art", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.25, "discounted_cash": 128.0, "minimum": 121.06, "maximum": 374.8177, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 163.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.51 } ] } ] }, { "description": "Hepatitis B Core Antibody, IgM", "code_information": [ { "code": "86705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.25, "discounted_cash": 35.0, "minimum": 34.575, "maximum": 109.91, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.27 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 87.04, "10th_percentile": 87.04, "90th_percentile": 87.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 115.25, "10th_percentile": 108.75, "90th_percentile": 115.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.88, "10th_percentile": 34.8, "90th_percentile": 36.88, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 6679.4881, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 3863.72, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6874.74, "10th_percentile": 6874.74, "90th_percentile": 6874.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6673.74 } ] } ] }, { "description": "XR TM Joints Bilateral", "code_information": [ { "code": "70330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 617.5, "discounted_cash": 191.0, "minimum": 138.58, "maximum": 560.0725, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 352.49 } ] } ] }, { "description": "SKIN ULCERS WITH MCC", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12235.0, "minimum": 12235.11, "maximum": 22815.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22815.21 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [ { "code": "372", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 36481.7132, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7727.44, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6874.74, "10th_percentile": 6874.74, "90th_percentile": 6874.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12036.55 } ] } ] }, { "description": "NM Thyroid Mets Image w Addl Study", "code_information": [ { "code": "78016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1218.75, "discounted_cash": 377.0, "minimum": 365.625, "maximum": 1218.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1064.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1218.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1218.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1218.75 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "730", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 7922.19, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7922.19 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 16320.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16320.66 } ] } ] }, { "description": "$ Complete Blood Count with Differential 85025", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.25, "discounted_cash": 29.0, "minimum": 28.275, "maximum": 85.4848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 59.19, "10th_percentile": 59.19, "90th_percentile": 59.19, "count": "36" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.41, "10th_percentile": 40.05, "90th_percentile": 42.41, "count": "312" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.76, "10th_percentile": 29.05, "90th_percentile": 30.76, "count": "345" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 59.94, "10th_percentile": 56.6, "90th_percentile": 77.19, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 71.24, "10th_percentile": 71.24, "90th_percentile": 71.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 89.0, "10th_percentile": 14.48, "90th_percentile": 94.25, "count": "48" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 68.89, "10th_percentile": 18.22, "90th_percentile": 72.29, "count": "21" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 94.25, "10th_percentile": 89.0, "90th_percentile": 94.25, "count": "1222" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.16, "count": "1137" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 52.67, "10th_percentile": 52.67, "90th_percentile": 52.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.16, "count": "697" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.16, "count": "261" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.16, "count": "113" } ] } ] }, { "description": "MRI Spectroscopy 76390", "code_information": [ { "code": "76390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1928.75, "discounted_cash": 597.0, "minimum": 578.625, "maximum": 1928.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1928.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1928.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1928.75 } ] } ] }, { "description": "E.coli 0157 Latex (oxoid)", "code_information": [ { "code": "87335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 9.0, "minimum": 9.0, "maximum": 30.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.6, "10th_percentile": 9.3, "90th_percentile": 12.66, "count": "1 through 10" } ] } ] }, { "description": "Paraffin Bath OT", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.25, "discounted_cash": 22.0, "minimum": 21.375, "maximum": 71.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.25 } ] } ] }, { "description": ".Thrombin Clotting Time", "code_information": [ { "code": "85670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.5, "discounted_cash": 22.0, "minimum": 21.45, "maximum": 64.8505, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 71.5, "10th_percentile": 71.5, "90th_percentile": 71.5, "count": "1 through 10" } ] } ] }, { "description": "Rad Ther Cont Med Rad Physics Consult", "code_information": [ { "code": "77336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 678.75, "discounted_cash": 210.0, "minimum": 203.625, "maximum": 615.6263, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 343.68 } ] } ] }, { "description": "Crystal Analysis-Synovial Fluid", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.25, "discounted_cash": 31.0, "minimum": 30.075, "maximum": 90.9267, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 31.08, "10th_percentile": 31.08, "90th_percentile": 31.08, "count": "1 through 10" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 25213.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25213.09 } ] } ] }, { "description": "Iron Level", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.5, "discounted_cash": 24.0, "minimum": 23.25, "maximum": 70.2925, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 51.54, "10th_percentile": 51.54, "90th_percentile": 59.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.88, "10th_percentile": 34.88, "90th_percentile": 34.88, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.3, "10th_percentile": 25.3, "90th_percentile": 25.3, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.45 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 49.29, "10th_percentile": 49.29, "90th_percentile": 49.29, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 60.86, "10th_percentile": 60.86, "90th_percentile": 62.03, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 77.5, "10th_percentile": 19.97, "90th_percentile": 77.5, "count": "17" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 51.54, "10th_percentile": 14.98, "90th_percentile": 59.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 77.5, "10th_percentile": 77.5, "90th_percentile": 77.5, "count": "125" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 24.8, "count": "152" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 70.29, "10th_percentile": 24.8, "90th_percentile": 70.99, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 24.8, "count": "85" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 24.8, "count": "13" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 24.8, "count": "13" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 6413.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6413.21 } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 41575.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41575.02 } ] } ] }, { "description": "Influenza A Ab, CSF", "code_information": [ { "code": "86710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.0, "discounted_cash": 73.0, "minimum": 66.77, "maximum": 215.866, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.31 } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 40 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009003930", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 42.86, "10th_percentile": 42.86, "90th_percentile": 42.86, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 52.1, "10th_percentile": 52.1, "90th_percentile": 52.1, "count": "1 through 10" } ] } ] }, { "description": "MRI Brain wo Contrast", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1743.0, "discounted_cash": 540.0, "minimum": 522.9, "maximum": 1743.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1336.88, "10th_percentile": 1336.88, "90th_percentile": 1349.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 784.35, "10th_percentile": 784.35, "90th_percentile": 784.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1743.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 568.92, "10th_percentile": 568.92, "90th_percentile": 568.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1743.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1395.1, "10th_percentile": 1395.1, "90th_percentile": 1395.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 1743.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1336.88, "10th_percentile": 1336.88, "90th_percentile": 1336.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1743.0, "10th_percentile": 1743.0, "90th_percentile": 1743.0, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 557.76, "10th_percentile": 540.33, "90th_percentile": 557.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 557.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 557.76, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 557.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 557.76, "count": "1 through 10" } ] } ] }, { "description": "CT Lung Screen 71271", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 385.0, "discounted_cash": 119.0, "minimum": 115.5, "maximum": 385.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 173.25, "10th_percentile": 163.46, "90th_percentile": 173.25, "count": "25" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 385.0, "10th_percentile": 363.25, "90th_percentile": 385.0, "count": "46" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 125.66, "10th_percentile": 118.56, "90th_percentile": 125.66, "count": "17" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 302.34, "10th_percentile": 290.75, "90th_percentile": 302.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.2, "10th_percentile": 116.24, "90th_percentile": 123.2, "count": "28" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 124.61, "10th_percentile": 124.61, "90th_percentile": 124.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 385.0, "10th_percentile": 363.25, "90th_percentile": 385.0, "count": "53" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.2, "10th_percentile": 116.24, "90th_percentile": 123.2, "count": "60" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 123.2, "10th_percentile": 116.24, "90th_percentile": 123.2, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.2, "10th_percentile": 116.24, "90th_percentile": 123.2, "count": "42" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.2, "10th_percentile": 116.24, "90th_percentile": 123.2, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.2, "10th_percentile": 116.24, "90th_percentile": 123.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 295.3, "10th_percentile": 281.16, "90th_percentile": 295.3, "count": "1 through 10" } ] } ] }, { "description": "zzKOH Prep", "code_information": [ { "code": "87220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.0, "discounted_cash": 28.0, "minimum": 26.03, "maximum": 83.444, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.8 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 17687.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17687.01 } ] } ] }, { "description": "XR Arthrogram Wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 872.5, "discounted_cash": 270.0, "minimum": 261.75, "maximum": 872.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 297.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 402.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 402.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 872.5 } ] } ] }, { "description": "Des-gamma-carboxy Prothrombin", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.5, "discounted_cash": 73.0, "minimum": 71.55, "maximum": 238.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 238.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 238.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 238.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.5 } ] } ] }, { "description": "Hepatitis A Antibodies,Total", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.5, "discounted_cash": 46.0, "minimum": 44.55, "maximum": 134.6895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 66.83, "10th_percentile": 66.83, "90th_percentile": 66.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.35 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 112.06, "10th_percentile": 112.06, "90th_percentile": 112.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 148.5, "10th_percentile": 140.0, "90th_percentile": 148.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 44.8, "10th_percentile": 44.8, "90th_percentile": 44.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.8, "10th_percentile": 44.8, "90th_percentile": 47.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 47.52, "10th_percentile": 47.52, "90th_percentile": 47.52, "count": "1 through 10" } ] } ] }, { "description": "Cystic Fibrosis (CFTR) 165 Pathogenic Variants.", "code_information": [ { "code": "81220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 680.5, "discounted_cash": 210.0, "minimum": 204.15, "maximum": 680.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 680.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 680.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 680.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 680.5 } ] } ] }, { "description": "Calculi (Stone) Analysis", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249.5, "discounted_cash": 77.0, "minimum": 74.85, "maximum": 226.2965, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 199.05, "10th_percentile": 199.05, "90th_percentile": 199.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.84, "10th_percentile": 79.84, "90th_percentile": 79.84, "count": "1 through 10" } ] } ] }, { "description": "Rbc antibody identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.25, "discounted_cash": 112.0, "minimum": 109.275, "maximum": 364.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 213.41, "10th_percentile": 213.41, "90th_percentile": 213.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 364.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 151.76, "10th_percentile": 151.76, "90th_percentile": 151.76, "count": "1 through 10" } ] } ] }, { "description": "Adenovirus", "code_information": [ { "code": "87633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 396.5, "discounted_cash": 122.0, "minimum": 118.95, "maximum": 396.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 396.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 396.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 122.07, "10th_percentile": 122.07, "90th_percentile": 129.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 396.5 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 311.37, "10th_percentile": 311.37, "90th_percentile": 311.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 396.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 304.12, "10th_percentile": 304.12, "90th_percentile": 304.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 374.0, "10th_percentile": 374.0, "90th_percentile": 396.5, "count": "74" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.68, "10th_percentile": 119.68, "90th_percentile": 126.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 126.88, "10th_percentile": 126.88, "90th_percentile": 359.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 126.88, "10th_percentile": 126.88, "90th_percentile": 126.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 126.88, "10th_percentile": 119.68, "90th_percentile": 126.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.68, "10th_percentile": 119.68, "90th_percentile": 119.68, "count": "1 through 10" } ] } ] }, { "description": "NM Renal Scan w Pharm Single", "code_information": [ { "code": "78708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1188.25, "discounted_cash": 368.0, "minimum": 356.475, "maximum": 1077.7427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 528.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 715.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 715.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1015.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1188.25, "10th_percentile": 1188.25, "90th_percentile": 1188.25, "count": "1 through 10" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 10263.2633, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9190.69 } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITH CCMCC", "code_information": [ { "code": "116", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 21315.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21315.65 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18030.0, "minimum": 18030.68, "maximum": 55311.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55311.54 } ] } ] }, { "description": ".JAK2 Exons 12, 13 Mutations, Qual", "code_information": [ { "code": "81403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1863.75, "discounted_cash": 577.0, "minimum": 559.125, "maximum": 1761.72, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1556.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1206.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1726.36 } ] } ] }, { "description": "NM Thyroid Image Only", "code_information": [ { "code": "78013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.75, "discounted_cash": 202.0, "minimum": 196.425, "maximum": 654.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 643.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 654.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 654.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 654.75 } ] } ] }, { "description": "TPMT Genetics, Prometheus", "code_information": [ { "code": "81401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1489.5, "discounted_cash": 461.0, "minimum": 200.89, "maximum": 1350.9765, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 293.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 200.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1277.06 } ] } ] }, { "description": "$ Clostridum difficile A+B", "code_information": [ { "code": "87324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 67.0, "minimum": 64.875, "maximum": 196.1387, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.67 } ] } ] }, { "description": "IV Infusion Hydration 1 - 8 Hr", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.0, "discounted_cash": 100.0, "minimum": 97.2, "maximum": 293.868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 215.46, "10th_percentile": 170.41, "90th_percentile": 430.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 145.8, "10th_percentile": 145.8, "90th_percentile": 874.8, "count": "24" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 214.62, "10th_percentile": 214.62, "90th_percentile": 214.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.75, "10th_percentile": 105.75, "90th_percentile": 317.26, "count": "31" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 2177.99, "10th_percentile": 293.87, "90th_percentile": 3966.06, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 295.89, "10th_percentile": 103.68, "90th_percentile": 725.76, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 250.78, "10th_percentile": 110.17, "90th_percentile": 497.02, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 324.0, "10th_percentile": 324.0, "90th_percentile": 648.0, "count": "199" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.68, "10th_percentile": 103.68, "90th_percentile": 207.36, "count": "75" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 181.06, "10th_percentile": 181.06, "90th_percentile": 181.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.68, "10th_percentile": 103.68, "90th_percentile": 207.36, "count": "52" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.68, "10th_percentile": 103.68, "90th_percentile": 207.36, "count": "36" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.68, "10th_percentile": 103.68, "90th_percentile": 207.36, "count": "14" } ] } ] }, { "description": "Phonophoresis/15M OPRS OT", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 29.0, "minimum": 28.2, "maximum": 94.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.0 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3434.0, "minimum": 3434.42, "maximum": 18294.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18294.14 } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "330", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 28260.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28260.54 } ] } ] }, { "description": "Osteocalcin", "code_information": [ { "code": "83937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.75, "discounted_cash": 111.0, "minimum": 108.225, "maximum": 327.2002, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 246.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 190.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 278.25 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 7431.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7431.77 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12449.0, "minimum": 12449.76, "maximum": 49381.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49381.68 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 8352.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8352.49 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 12451.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12451.52 } ] } ] }, { "description": "CSF Oligoclonal Bands", "code_information": [ { "code": "83916", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 54.0, "minimum": 52.5, "maximum": 175.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 165.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 128.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.0 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [ { "code": "823", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21679.0, "minimum": 21679.75, "maximum": 54050.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54050.12 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 19336.1859, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 16741.68, "standard_charge_algorithm": "78.53% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13154.94, "10th_percentile": 13154.94, "90th_percentile": 13154.94, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7402.23, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 16498.95, "10th_percentile": 16498.95, "90th_percentile": 16498.95, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7083.48, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4293.02, "10th_percentile": 4293.02, "90th_percentile": 4293.02, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10407.31 } ] } ] }, { "description": "MRI Additional 30 minutes implant 76015", "code_information": [ { "code": "76015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.5, "discounted_cash": 22.0, "minimum": 22.05, "maximum": 73.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.5 } ] } ] }, { "description": "88331 AP Bill Frozen single specimen", "code_information": [ { "code": "88331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.75, "discounted_cash": 121.0, "minimum": 117.825, "maximum": 392.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.75 } ] } ] }, { "description": "URETHRAL STRICTURE", "code_information": [ { "code": "697", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 12706.16, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12706.16 } ] } ] }, { "description": "Lidocaine Inj 2% w/ Epinephrine-1:100000", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323048303", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 17.15, "10th_percentile": 17.15, "90th_percentile": 17.15, "count": "1 through 10" } ] } ] }, { "description": "Clozapine & Metabolites Quantitative", "code_information": [ { "code": "80159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.25, "discounted_cash": 26.0, "minimum": 25.575, "maximum": 85.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.25 } ] } ] }, { "description": "Enterovirus Detection by PCR", "code_information": [ { "code": "87498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.0, "discounted_cash": 112.0, "minimum": 109.2, "maximum": 330.148, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09 } ] } ] }, { "description": "XR Sternoclavicular Joints Min 3 Views", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.75, "discounted_cash": 138.0, "minimum": 105.05, "maximum": 404.2953, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 142.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.27 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [ { "code": "660", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 15581.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15581.49 } ] } ] }, { "description": "Poliovirus Ab Type 1 - 86382 - 3350487 - 3350487", "code_information": [ { "code": "86382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.75, "discounted_cash": 84.0, "minimum": 81.525, "maximum": 246.4772, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.63 } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [ { "code": "918", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 10104.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10104.33 } ] } ] }, { "description": "IR Venogram Epidural", "code_information": [ { "code": "75872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1408.25, "discounted_cash": 436.0, "minimum": 422.475, "maximum": 1277.2828, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 939.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1272.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1272.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.5 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "599", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 9070.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9070.44 } ] } ] }, { "description": "SLP Eval of Speech Sound Prod Units", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.0, "discounted_cash": 107.0, "minimum": 95.0, "maximum": 314.729, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "695", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 13484.24, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13484.24 } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [ { "code": "871", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 9041.9825, "maximum": 22900.09, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 10303.25, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7392.36, "10th_percentile": 7392.36, "90th_percentile": 7392.36, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 10303.25, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6874.74, "10th_percentile": 2291.58, "90th_percentile": 16041.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 15039.57, "standard_charge_algorithm": "90.7% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 2291.58, "10th_percentile": 2291.58, "90th_percentile": 2291.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 10303.25, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3064.0, "10th_percentile": 3064.0, "90th_percentile": 3064.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22900.09 } ] } ] }, { "description": "NM Tumor Imaging WB Multi", "code_information": [ { "code": "78804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2264.5, "discounted_cash": 701.0, "minimum": 679.35, "maximum": 2264.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2021.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2264.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2264.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2264.5 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 34731.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34731.51 } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 20622.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20622.46 } ] } ] }, { "description": "Bill HIV GT Phenotype, additional", "code_information": [ { "code": "87904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.25, "discounted_cash": 32.0, "minimum": 31.275, "maximum": 104.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.25 } ] } ] }, { "description": "IGVH Status", "code_information": [ { "code": "81263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1025.0, "discounted_cash": 317.0, "minimum": 307.5, "maximum": 1025.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 } ] } ] }, { "description": "OTHER O.R. 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"plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.43 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55165.0, "minimum": 55165.31, "maximum": 141678.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 141678.78 } ] } ] }, { "description": "XR Wrist Right AP+Lateral", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.5, "discounted_cash": 107.0, "minimum": 78.79, "maximum": 315.1825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 266.53, "10th_percentile": 266.53, "90th_percentile": 266.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 327.75, "10th_percentile": 327.75, "90th_percentile": 347.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 111.2, "count": "1 through 10" } ] } ] }, { "description": "MRI Angio Chest w Contrast", "code_information": [ { "code": "71555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "discounted_cash": 930.0, "minimum": 900.0, "maximum": 2721.6802, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2340.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2340.82 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2196.84 } ] } ] }, { "description": "XR Perc Tube-Catheter Change", "code_information": [ { "code": "75984", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1146.75, "discounted_cash": 355.0, "minimum": 310.73, "maximum": 1040.1022, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 310.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 420.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 490.66 } ] } ] }, { "description": "Phosphatidylglycerol Amniotic Fluid", "code_information": [ { "code": "84081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.25, "discounted_cash": 58.0, "minimum": 56.775, "maximum": 171.6498, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 136.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 154.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.99 } ] } ] }, { "description": "Bill IRL Agn Pheno per Unit", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 539.75, "discounted_cash": 167.0, "minimum": 49.55, "maximum": 489.5532, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.24 } ] } ] }, { "description": "Influenza A NAT", "code_information": [ { "code": "87502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 383.25, "discounted_cash": 118.0, "minimum": 114.975, "maximum": 383.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 383.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 383.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 346.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 383.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 361.5, "10th_percentile": 361.5, "90th_percentile": 361.5, "count": "1 through 10" } ] } ] }, { "description": "NM MUGA Gated Cardiac Multi Planar", "code_information": [ { "code": "78473", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2219.75, "discounted_cash": 688.0, "minimum": 665.925, "maximum": 2013.3132, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1120.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1517.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1517.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1700.51 } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "512", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 19515.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19515.48 } ] } ] }, { "description": "Triiodothyronine, Total (T3)", "code_information": [ { "code": "84480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.5, "discounted_cash": 48.0, "minimum": 46.65, "maximum": 141.0385, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 103.41, "10th_percentile": 103.41, "90th_percentile": 103.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.98, "10th_percentile": 69.98, "90th_percentile": 69.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.76, "10th_percentile": 50.76, "90th_percentile": 50.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 90.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 98.9, "10th_percentile": 98.9, "90th_percentile": 98.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 155.5, "10th_percentile": 155.5, "90th_percentile": 155.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 155.5, "10th_percentile": 155.5, "90th_percentile": 155.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.76, "10th_percentile": 49.76, "90th_percentile": 49.76, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.76, "10th_percentile": 49.76, "90th_percentile": 49.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.76, "10th_percentile": 49.76, "90th_percentile": 49.76, "count": "1 through 10" } ] } ] }, { "description": "OT Group Train WO Patient Unit", "code_information": [ { "code": "G0543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.5, "minimum": 26.85, "maximum": 89.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.5 } ] } ] }, { "description": "XR Sinuses Limited 1-2 Views", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 374.25, "discounted_cash": 116.0, "minimum": 84.62, "maximum": 339.4447, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.05 } ] } ] }, { "description": "96360 - ED IV Infusion Hydration 31 min/1 HR", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 61.0, "minimum": 59.4, "maximum": 179.586, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 131.67, "10th_percentile": 131.67, "90th_percentile": 131.67, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 89.1, "10th_percentile": 89.1, "90th_percentile": 89.1, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 37.3, "10th_percentile": 37.3, "90th_percentile": 37.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.63, "10th_percentile": 64.63, "90th_percentile": 64.63, "count": "19" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 198.0, "10th_percentile": 63.36, "90th_percentile": 198.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 67.32, "10th_percentile": 67.32, "90th_percentile": 67.32, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 198.0, "10th_percentile": 198.0, "90th_percentile": 198.0, "count": "72" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 63.36, "count": "49" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 179.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 63.36, "count": "35" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 63.36, "count": "13" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 63.36, "count": "1 through 10" } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "419", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 16101.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16101.39 } ] } ] }, { "description": "NASAL HEMORR POST 1 FAC", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.5, "discounted_cash": 121.0, "minimum": 117.45, "maximum": 355.0905, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 176.18, "10th_percentile": 176.18, "90th_percentile": 176.18, "count": "1 through 10" } ] } ] }, { "description": "Strep pneumoniae 7F IgG", "code_information": [ { "code": "86317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 32.0, "minimum": 31.5, "maximum": 105.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.0 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9873.0, "minimum": 9873.95, "maximum": 19218.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19218.4 } ] } ] }, { "description": "XR UGI Double Contrast 74246", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.75, "discounted_cash": 292.0, "minimum": 283.125, "maximum": 855.9813, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 350.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 474.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 474.09 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 712.56, "10th_percentile": 712.56, "90th_percentile": 712.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 820.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 302.0, "10th_percentile": 302.0, "90th_percentile": 302.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 943.75, "10th_percentile": 943.75, "90th_percentile": 943.75, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 9310.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9310.94 } ] } ] }, { "description": "XR IVP", "code_information": [ { "code": "74400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1625.25, "discounted_cash": 503.0, "minimum": 338.44, "maximum": 1474.1018, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 458.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 458.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.51 } ] } ] }, { "description": "C1-Esterase Inhibitor", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 63.0, "minimum": 61.2, "maximum": 185.028, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.86 } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 25729.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25729.45 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 7357.9099, "maximum": 15134.69, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8156.74, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4583.16, "10th_percentile": 2291.58, "90th_percentile": 4583.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8156.74, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3064.0, "10th_percentile": 3064.0, "90th_percentile": 3064.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15134.69 } ] } ] }, { "description": "GLUCOSE BLD MNTR DV FAC", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 9.0, "minimum": 9.0, "maximum": 30.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 } ] } ] }, { "description": "PKU", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.0, "discounted_cash": 97.0, "minimum": 35.23, "maximum": 283.891, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.27 } ] } ] }, { "description": "PCB Panel, Congers, Serum/Plasma", "code_information": [ { "code": "82441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.25, "discounted_cash": 65.0, "minimum": 38.38, "maximum": 191.6037, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.02 } ] } ] }, { "description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CCMCC", "code_information": [ { "code": "537", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 3835.3512, "maximum": 11250.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11250.22 } ] } ] }, { "description": "PSA, Free", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.0, "discounted_cash": 99.0, "minimum": 96.6, "maximum": 292.054, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 274.0, "10th_percentile": 274.0, "90th_percentile": 274.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 144.9, "10th_percentile": 144.9, "90th_percentile": 144.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 322.0, "10th_percentile": 322.0, "90th_percentile": 322.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.04, "10th_percentile": 18.39, "90th_percentile": 103.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.04, "10th_percentile": 103.04, "90th_percentile": 103.04, "count": "1 through 10" } ] } ] }, { "description": "CT Angiography Neck w+wo Contrast", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1521.0, "discounted_cash": 471.0, "minimum": 456.3, "maximum": 1521.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 583.3, "10th_percentile": 583.3, "90th_percentile": 583.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 322.88, "10th_percentile": 322.88, "90th_percentile": 342.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1521.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 496.45, "10th_percentile": 468.38, "90th_percentile": 496.45, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1521.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1148.57, "10th_percentile": 1148.57, "90th_percentile": 1148.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1521.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1435.0, "10th_percentile": 1435.0, "90th_percentile": 1435.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1166.61, "10th_percentile": 1166.61, "90th_percentile": 1166.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1521.0, "10th_percentile": 1435.0, "90th_percentile": 1521.0, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 459.2, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1144.84, "10th_percentile": 1144.84, "90th_percentile": 1144.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 486.72, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 486.72, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 459.2, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "1 through 10" } ] } ] }, { "description": "Ther Ivntj 1st 15 Min OT", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.75, "discounted_cash": 29.0, "minimum": 28.725, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [ { "code": "082", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 9444.64, "maximum": 26944.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26944.89 } ] } ] }, { "description": "Atypical P-ANCA Titer", "code_information": [ { "code": "86021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.0, "discounted_cash": 16.0, "minimum": 15.9, "maximum": 53.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.0 } ] } ] }, { "description": "Erythrocyte Porphyrin (EP), Whole Blood", "code_information": [ { "code": "84202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.5, "discounted_cash": 108.0, "minimum": 91.79, "maximum": 318.8105, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.77 } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "370", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 8261.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8261.72 } ] } ] }, { "description": "URETHRAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "671", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 21161.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21161.22 } ] } ] }, { "description": "Diabetic Ed Group Session 5-8 ppl 30 Min - G0109 - 1250145", "code_information": [ { "code": "G0109", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "minimum": 16.5, "maximum": 68.7053, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.28, "10th_percentile": 73.28, "90th_percentile": 73.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.28, "10th_percentile": 54.72, "90th_percentile": 109.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.28, "10th_percentile": 73.28, "90th_percentile": 109.92, "count": "1 through 10" } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "583", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 20328.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20328.92 } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [ { "code": "071", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 22034.6897, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7083.48, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4928.24, "10th_percentile": 4928.24, "90th_percentile": 4928.24, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12095.49 } ] } ] }, { "description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [ { "code": "866", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 10251.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10251.7 } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [ { "code": "278", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15454.0, "minimum": 15454.87, "maximum": 65619.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65619.82 } ] } ] }, { "description": "MRI Elbow Left w Contrast", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2214.75, "discounted_cash": 686.0, "minimum": 664.425, "maximum": 2214.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2214.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2214.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2081.21 } ] } ] }, { "description": "$ Comprehensive Metabolic Panel 80053", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.5, "discounted_cash": 83.0, "minimum": 67.65, "maximum": 244.4365, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 121.28, "10th_percentile": 114.41, "90th_percentile": 121.28, "count": "382" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 87.96, "10th_percentile": 82.99, "90th_percentile": 87.96, "count": "338" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67.65 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 171.4, "10th_percentile": 104.24, "90th_percentile": 220.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 211.64, "10th_percentile": 203.5, "90th_percentile": 211.64, "count": "141" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 126.74, "10th_percentile": 59.6, "90th_percentile": 269.5, "count": "84" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 196.79, "10th_percentile": 52.09, "90th_percentile": 206.71, "count": "24" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 269.5, "10th_percentile": 254.25, "90th_percentile": 269.5, "count": "1365" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.24, "count": "1057" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 150.61, "10th_percentile": 150.61, "90th_percentile": 150.61, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.24, "count": "700" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.24, "count": "248" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.24, "count": "94" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 169.08, "10th_percentile": 169.08, "90th_percentile": 169.08, "count": "40" } ] } ] }, { "description": "XR Nephrostogram-Loopogram", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1163.25, "discounted_cash": 360.0, "minimum": 205.68, "maximum": 1055.0677, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 205.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 278.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 950.38 } ] } ] }, { "description": "Ethosuximide Level", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.75, "discounted_cash": 14.0, "minimum": 13.725, "maximum": 45.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.75 } ] } ] }, { "description": "CT Panc Mass Protocol abd only", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3122.5, "discounted_cash": 967.0, "minimum": 650.0, "maximum": 2832.1075, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1866.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1866.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1723.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 942.64, "10th_percentile": 942.64, "90th_percentile": 942.64, "count": "1 through 10" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11376.0, "minimum": 11376.5, "maximum": 44058.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44058.95 } ] } ] }, { "description": "OT Eval Mod Complex", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.5, "discounted_cash": 155.0, "minimum": 95.0, "maximum": 454.8605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 225.68, "10th_percentile": 225.68, "90th_percentile": 225.68, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.48, "10th_percentile": 32.1, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" } ] } ] }, { "description": "Procainamide Level", "code_information": [ { "code": "80192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 52.0, "minimum": 50.625, "maximum": 156.48, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.14 } ] } ] }, { "description": "Carbamazepine Level", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.25, "discounted_cash": 59.0, "minimum": 57.375, "maximum": 173.4638, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.15 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 150.19, "10th_percentile": 150.19, "90th_percentile": 150.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 108.99, "10th_percentile": 108.99, "90th_percentile": 108.99, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.76, "10th_percentile": 57.76, "90th_percentile": 61.2, "count": "1 through 10" } ] } ] }, { "description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [ { "code": "029", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 40219.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40219.28 } ] } ] }, { "description": "Stool, Occult Blood, 3 Screening Samples - G0328 - 3203002", "code_information": [ { "code": "G0328", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.5, "minimum": 18.15, "maximum": 60.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.05, "10th_percentile": 18.05, "90th_percentile": 18.05, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.24, "10th_percentile": 18.24, "90th_percentile": 18.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.36, "10th_percentile": 19.36, "90th_percentile": 19.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.05, "10th_percentile": 18.05, "90th_percentile": 19.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.36, "10th_percentile": 19.36, "90th_percentile": 19.36, "count": "1 through 10" } ] } ] }, { "description": "PLEURAL EFFUSION WITH MCC", "code_information": [ { "code": "186", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9015.0, "minimum": 9015.34, "maximum": 18373.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18373.13 } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC", "code_information": [ { "code": "510", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11376.0, "minimum": 11376.5, "maximum": 35608.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35608.61 } ] } ] }, { "description": "Bill Parasite Conc", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.5, "discounted_cash": 25.0, "minimum": 25.05, "maximum": 75.7345, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.27 } ] } ] }, { "description": "URINARY STONES WITHOUT MCC", "code_information": [ { "code": "694", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 9215.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9215.45 } ] } ] }, { "description": "Bart. henselea Ab, IgM", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.75, "discounted_cash": 17.0, "minimum": 17.325, "maximum": 57.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.75 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CCMCC", "code_information": [ { "code": "688", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 9316.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9316.83 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 11965.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11965.81 } ] } ] }, { "description": "XR VCUG in Radiology", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 776.25, "discounted_cash": 240.0, "minimum": 232.875, "maximum": 750.1279, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 294.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 399.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 399.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 750.13 } ] } ] }, { "description": "$ General Health Panel", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 576.5, "discounted_cash": 178.0, "minimum": 172.95, "maximum": 522.8855, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 435.22, "10th_percentile": 435.22, "90th_percentile": 435.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.71 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 15422.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15422.34 } ] } ] }, { "description": "75898 FAC FOLLOW-UP ANGIOGRAPHY", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.25, "discounted_cash": 93.0, "minimum": 90.675, "maximum": 302.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 231.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 302.25 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 19575.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19575.6 } ] } ] }, { "description": "Somatostatin Quantitative, Plasma", "code_information": [ { "code": "84307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 595.25, "discounted_cash": 184.0, "minimum": 108.14, "maximum": 539.8918, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.4 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [ { "code": "516", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 24498.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24498.68 } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 18094.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18094.91 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "832", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 8506.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8506.93 } ] } ] }, { "description": "88173 AP Bill FNA Interp and report", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.25, "discounted_cash": 43.0, "minimum": 42.375, "maximum": 141.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.25 } ] } ] }, { "description": "IR Hepatic Venogram wo Press 75891", "code_information": [ { "code": "75891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6086.75, "discounted_cash": 1886.0, "minimum": 617.6279, "maximum": 5520.6822, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 844.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1143.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1143.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.63 } ] } ] }, { "description": "Kleihauer-Betke (RhIG))", "code_information": [ { "code": "85460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.25, "discounted_cash": 97.0, "minimum": 49.51, "maximum": 285.9318, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.06 } ] } ] }, { "description": "U Cyc AMP", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.75, "discounted_cash": 99.0, "minimum": 95.925, "maximum": 290.0133, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 212.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 240.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 165.05 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.5 } ] } ] }, { "description": "Total Bili, (Fibrotest)", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.5, "discounted_cash": 41.0, "minimum": 32.12, "maximum": 121.0845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 32.31, "10th_percentile": 32.31, "90th_percentile": 32.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.79, "10th_percentile": 18.79, "90th_percentile": 18.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 50.0, "10th_percentile": 41.75, "90th_percentile": 133.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 42.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 45.8, "10th_percentile": 45.8, "90th_percentile": 45.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 13.36, "count": "1 through 10" } ] } ] }, { "description": "MRI Angio Pelvis wo 72198", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2104.0, "discounted_cash": 652.0, "minimum": 631.2, "maximum": 2104.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2104.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2104.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2104.0 } ] } ] }, { "description": "Differential WBC", "code_information": [ { "code": "85004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.75, "discounted_cash": 9.0, "minimum": 9.225, "maximum": 30.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 29.0, "10th_percentile": 29.0, "90th_percentile": 29.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 30.75, "10th_percentile": 30.75, "90th_percentile": 30.75, "count": "1 through 10" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 21004.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21004.43 } ] } ] }, { "description": "US Retroperitoneal Complete", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 948.75, "discounted_cash": 294.0, "minimum": 284.625, "maximum": 860.5163, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 402.75, "10th_percentile": 402.75, "90th_percentile": 426.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 507.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 309.67, "10th_percentile": 292.13, "90th_percentile": 309.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 507.66 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 603.41, "10th_percentile": 569.22, "90th_percentile": 603.41, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 716.36, "10th_percentile": 716.36, "90th_percentile": 716.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 303.6, "10th_percentile": 286.4, "90th_percentile": 303.6, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 727.69, "10th_percentile": 727.69, "90th_percentile": 727.69, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 948.75, "10th_percentile": 895.0, "90th_percentile": 948.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 303.6, "10th_percentile": 286.4, "90th_percentile": 303.6, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 819.82, "10th_percentile": 819.82, "90th_percentile": 819.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 303.6, "10th_percentile": 286.4, "90th_percentile": 303.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 303.6, "10th_percentile": 303.6, "90th_percentile": 303.6, "count": "1 through 10" } ] } ] }, { "description": "SIM REP FACE <2.5 FAC", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 123.0, "minimum": 119.4, "maximum": 360.986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 305.27, "10th_percentile": 305.27, "90th_percentile": 305.27, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 179.1, "10th_percentile": 170.55, "90th_percentile": 179.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 113.75, "10th_percentile": 113.75, "90th_percentile": 123.71, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 325.96, "10th_percentile": 285.42, "90th_percentile": 325.97, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 312.55, "10th_percentile": 312.55, "90th_percentile": 312.55, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 72.99, "10th_percentile": 72.99, "90th_percentile": 72.99, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 379.0, "10th_percentile": 332.0, "90th_percentile": 398.0, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 121.28, "10th_percentile": 106.24, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 360.99, "10th_percentile": 360.99, "90th_percentile": 360.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 121.28, "10th_percentile": 121.28, "90th_percentile": 121.28, "count": "1 through 10" } ] } ] }, { "description": "CT Angiography Head w+wo Contrast", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1528.0, "discounted_cash": 473.0, "minimum": 458.4, "maximum": 1528.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1171.98, "10th_percentile": 1171.98, "90th_percentile": 1171.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 648.68, "10th_percentile": 324.34, "90th_percentile": 687.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1528.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 498.74, "10th_percentile": 470.51, "90th_percentile": 498.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1528.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1153.78, "10th_percentile": 1153.78, "90th_percentile": 1199.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1528.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1441.5, "10th_percentile": 1441.5, "90th_percentile": 1441.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1171.98, "10th_percentile": 1171.98, "90th_percentile": 1171.98, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1528.0, "10th_percentile": 1441.5, "90th_percentile": 1528.0, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 461.28, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1150.03, "10th_percentile": 1150.03, "90th_percentile": 1150.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 488.96, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 488.96, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 461.28, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" } ] } ] }, { "description": "DHEA", "code_information": [ { "code": "82626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.5, "discounted_cash": 90.0, "minimum": 87.45, "maximum": 264.3905, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 236.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 161.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 291.5, "10th_percentile": 291.5, "90th_percentile": 291.5, "count": "1 through 10" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 29742.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29742.42 } ] } ] }, { "description": "Ketorolac Tromethamine Inj 30 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016243", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 11.86, "10th_percentile": 11.86, "90th_percentile": 11.86, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 13.81, "10th_percentile": 13.81, "90th_percentile": 14.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 10.57, "10th_percentile": 10.57, "90th_percentile": 17.14, "count": "1 through 10" } ] } ] }, { "description": "HYPERTENSION WITHOUT MCC", "code_information": [ { "code": "305", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 24733.6179, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8901.86 } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10517.0, "minimum": 10517.9, "maximum": 26060.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26060.72 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13093.0, "minimum": 13093.71, "maximum": 37969.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37969.95 } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC", "code_information": [ { "code": "640", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 16159.9691, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7727.44, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6394.65, "10th_percentile": 6394.65, "90th_percentile": 27710.15, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15745.36 } ] } ] }, { "description": "NM Brain Imaging Complete w Vasc Flow", "code_information": [ { "code": "78606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 434.0, "minimum": 420.525, "maximum": 1401.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1066.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1401.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1401.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1401.75 } ] } ] }, { "description": "Trichinella IgG Ab", "code_information": [ { "code": "86784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 49.0, "minimum": 47.625, "maximum": 143.9863, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.08 } ] } ] }, { "description": "Toxocara canis Ab, IgG", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.0, "discounted_cash": 104.0, "minimum": 62.44, "maximum": 306.566, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.06 } ] } ] }, { "description": "VENI >4YR PHYS FAC", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.75, "discounted_cash": 31.0, "minimum": 30.225, "maximum": 91.3803, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 100.75, "10th_percentile": 100.75, "90th_percentile": 100.75, "count": "1 through 10" } ] } ] }, { "description": "XR Ankle Left AP+Lateral", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.75, "discounted_cash": 96.0, "minimum": 74.39, "maximum": 282.7572, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 147.0, "10th_percentile": 147.0, "90th_percentile": 294.0, "count": "1 through 10" } ] } ] }, { "description": "Chemo IV Infusion Each Addl Hr", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.75, "discounted_cash": 77.0, "minimum": 74.625, "maximum": 225.6163, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 329.54, "10th_percentile": 164.77, "90th_percentile": 483.27, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 199.0, "10th_percentile": 199.0, "90th_percentile": 199.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 567.24, "10th_percentile": 378.16, "90th_percentile": 756.31, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 248.75, "10th_percentile": 237.0, "90th_percentile": 497.5, "count": "16" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 237.0, "10th_percentile": 237.0, "90th_percentile": 237.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.6, "10th_percentile": 75.84, "90th_percentile": 151.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 79.6, "10th_percentile": 75.84, "90th_percentile": 225.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 151.68, "10th_percentile": 79.6, "90th_percentile": 159.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 151.68, "count": "1 through 10" } ] } ] }, { "description": "MRI Implant initial 15 minutes 76014", "code_information": [ { "code": "76014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.5, "discounted_cash": 22.0, "minimum": 22.05, "maximum": 73.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.5 } ] } ] }, { "description": "CT Bone Length Study", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 735.5, "discounted_cash": 228.0, "minimum": 96.27, "maximum": 667.0985, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 735.5, "10th_percentile": 735.5, "90th_percentile": 735.5, "count": "1 through 10" } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "229", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 37129.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37129.39 } ] } ] }, { "description": "XR Salivary Gland", "code_information": [ { "code": "70380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 733.5, "discounted_cash": 227.0, "minimum": 112.33, "maximum": 665.2845, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 152.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.0 } ] } ] }, { "description": "SLP Team Conference 30 Min Non Physician Unit", "code_information": [ { "code": "99368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.0, "discounted_cash": 41.0, "minimum": 39.9, "maximum": 120.631, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [ { "code": "902", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10088.0, "minimum": 10088.6, "maximum": 22570.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22570.0 } ] } ] }, { "description": "Histoplasma Ag, Urine", "code_information": [ { "code": "87385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "discounted_cash": 51.0, "minimum": 49.875, "maximum": 150.7887, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.51 } ] } ] }, { "description": "SO KRAS Mutation Detect2", "code_information": [ { "code": "81276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 791.5, "discounted_cash": 245.0, "minimum": 237.45, "maximum": 791.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 791.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 791.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 791.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 791.5 } ] } ] }, { "description": "Echo 2D Comprehensive w/Contrast - 93306 - 5001009", "code_information": [ { "code": "93306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.0, "discounted_cash": 785.0, "minimum": 760.5, "maximum": 2299.245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1685.78, "10th_percentile": 1685.78, "90th_percentile": 1685.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1140.75, "10th_percentile": 1140.75, "90th_percentile": 1140.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 1679.19, "10th_percentile": 1378.53, "90th_percentile": 1723.04, "count": "26" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 827.42, "10th_percentile": 827.42, "90th_percentile": 827.42, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 2076.17, "10th_percentile": 2028.0, "90th_percentile": 2076.17, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1990.74, "10th_percentile": 1990.74, "90th_percentile": 2029.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 2022.42, "10th_percentile": 2022.42, "90th_percentile": 2022.42, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 886.06, "10th_percentile": 858.86, "90th_percentile": 887.89, "count": "13" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1962.09, "10th_percentile": 1962.09, "90th_percentile": 1962.09, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2535.0, "10th_percentile": 2535.0, "90th_percentile": 2535.0, "count": "33" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 811.2, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2299.25, "10th_percentile": 811.2, "90th_percentile": 2299.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 886.07, "10th_percentile": 162.24, "90th_percentile": 1034.79, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 811.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 811.2, "count": "1 through 10" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CCMCC", "code_information": [ { "code": "829", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 12664.41, "maximum": 37253.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37253.18 } ] } ] }, { "description": "Fungal Culture, Skin Hair Nails", "code_information": [ { "code": "87101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 52.0, "minimum": 49.34, "maximum": 153.0563, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.87 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [ { "code": "500", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16313.0, "minimum": 16313.48, "maximum": 37309.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37309.76 } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 18871.0426, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6504.99, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 1053.03, "10th_percentile": 1053.03, "90th_percentile": 1053.03, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6224.88, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2131.55, "10th_percentile": 2131.55, "90th_percentile": 2131.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 18871.04, "standard_charge_algorithm": "90.7% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21663.34, "10th_percentile": 21663.34, "90th_percentile": 21663.34, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10565.28 } ] } ] }, { "description": "NM Liver+ Spleen Scan w Flow", "code_information": [ { "code": "78216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.5, "discounted_cash": 192.0, "minimum": 185.85, "maximum": 619.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 440.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 596.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 596.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 619.5 } ] } ] }, { "description": "Hepatitis C RNA Qualitative PCR", "code_information": [ { "code": "87521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.0, "discounted_cash": 121.0, "minimum": 117.9, "maximum": 356.451, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09 } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 20367.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20367.82 } ] } ] }, { "description": "VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 9728.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9728.27 } ] } ] }, { "description": "ROM Measurement Hand OT", "code_information": [ { "code": "95852", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.5, "discounted_cash": 17.0, "minimum": 17.25, "maximum": 57.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.5 } ] } ] }, { "description": "S aureus NAT - 87640 - 3150015 - 3150015", "code_information": [ { "code": "87640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.5, "discounted_cash": 65.0, "minimum": 63.45, "maximum": 211.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 132.67, "10th_percentile": 132.67, "90th_percentile": 132.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 211.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.12, "10th_percentile": 65.12, "90th_percentile": 69.03, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 126.88, "10th_percentile": 126.88, "90th_percentile": 126.88, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 159.68, "10th_percentile": 159.68, "90th_percentile": 166.09, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.84, "10th_percentile": 63.84, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 191.83, "10th_percentile": 67.68, "90th_percentile": 191.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.68, "10th_percentile": 63.84, "90th_percentile": 67.68, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.84, "10th_percentile": 63.84, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2361.0, "minimum": 2361.16, "maximum": 5365.16, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5365.16 } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [ { "code": "641", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 10061.2569, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5580.93, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2291.58, "10th_percentile": 2291.58, "90th_percentile": 2291.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 5580.93, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6128.0, "10th_percentile": 6128.0, "90th_percentile": 6128.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9174.18 } ] } ] }, { "description": "MRI Breast Bilat Post Clip 77047", "code_information": [ { "code": "77047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 988.25, "discounted_cash": 306.0, "minimum": 296.475, "maximum": 988.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.25 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12020.0, "minimum": 12020.46, "maximum": 30406.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30406.14 } ] } ] }, { "description": "Vitamin D 25-Hydroxy Level", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.25, "discounted_cash": 34.0, "minimum": 33.675, "maximum": 112.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 74.65, "10th_percentile": 74.65, "90th_percentile": 74.65, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.51, "10th_percentile": 50.51, "90th_percentile": 50.51, "count": "45" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.64, "10th_percentile": 36.64, "90th_percentile": 36.64, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 71.39, "10th_percentile": 71.39, "90th_percentile": 71.39, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 89.84, "10th_percentile": 88.15, "90th_percentile": 89.84, "count": "31" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 104.95, "10th_percentile": 29.48, "90th_percentile": 112.25, "count": "20" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 86.1, "10th_percentile": 86.1, "90th_percentile": 86.1, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 112.25, "10th_percentile": 112.25, "90th_percentile": 112.25, "count": "198" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "122" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 101.81, "10th_percentile": 35.92, "90th_percentile": 102.82, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "90" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "1 through 10" } ] } ] }, { "description": "Immunofixation Electrophoresis, Serum", "code_information": [ { "code": "86334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.25, "discounted_cash": 86.0, "minimum": 84.075, "maximum": 254.1867, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 92.48, "10th_percentile": 75.04, "90th_percentile": 97.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.08, "10th_percentile": 67.08, "90th_percentile": 67.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 142.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 217.75, "10th_percentile": 205.5, "90th_percentile": 217.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.76, "10th_percentile": 65.76, "90th_percentile": 69.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.76, "10th_percentile": 53.36, "90th_percentile": 69.68, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.68, "10th_percentile": 69.68, "90th_percentile": 69.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "1 through 10" } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITH CCMCC", "code_information": [ { "code": "135", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 25582.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25582.09 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15669.0, "minimum": 15669.52, "maximum": 41999.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41999.42 } ] } ] }, { "description": "Hepatitis D Virus Antibody", "code_information": [ { "code": "86692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.5, "discounted_cash": 79.0, "minimum": 76.65, "maximum": 231.7385, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.52 } ] } ] }, { "description": "99211 FAC NURSE VIS L1 - INFUSION THERAPY", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "discounted_cash": 34.0, "minimum": 33.0, "maximum": 99.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 17.96, "10th_percentile": 17.96, "90th_percentile": 17.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.2, "10th_percentile": 35.2, "90th_percentile": 35.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.77, "10th_percentile": 99.77, "90th_percentile": 99.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.2, "10th_percentile": 35.2, "90th_percentile": 35.2, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15669.0, "minimum": 15669.52, "maximum": 33604.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33604.49 } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [ { "code": "059", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 85891.6665, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14628.95 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITHOUT CCMCC", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 18096.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18096.08 } ] } ] }, { "description": "IV Infusion Concurrent.", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.25, "discounted_cash": 99.0, "minimum": 96.675, "maximum": 292.2808, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 247.17, "10th_percentile": 247.17, "90th_percentile": 247.17, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 145.01, "10th_percentile": 145.01, "90th_percentile": 145.01, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.18, "10th_percentile": 105.18, "90th_percentile": 105.18, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 322.25, "10th_percentile": 322.25, "90th_percentile": 322.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 322.25, "10th_percentile": 322.25, "90th_percentile": 322.25, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.12, "10th_percentile": 103.12, "90th_percentile": 103.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 103.12, "10th_percentile": 103.12, "90th_percentile": 103.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.12, "10th_percentile": 103.12, "90th_percentile": 103.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 103.12, "10th_percentile": 103.12, "90th_percentile": 103.12, "count": "1 through 10" } ] } ] }, { "description": "Lamotrigine (Lamictal) Level", "code_information": [ { "code": "80175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.75, "discounted_cash": 81.0, "minimum": 79.125, "maximum": 239.2212, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 192.53, "10th_percentile": 192.53, "90th_percentile": 202.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.6, "10th_percentile": 79.6, "90th_percentile": 84.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.6, "10th_percentile": 79.6, "90th_percentile": 79.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 79.6, "10th_percentile": 79.6, "90th_percentile": 79.6, "count": "1 through 10" } ] } ] }, { "description": "OT Orthotic, Prosthetic Use, Check Out", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.75, "discounted_cash": 44.0, "minimum": 42.825, "maximum": 129.4743, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "XR Single View 2 Or More Joints", "code_information": [ { "code": "77077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.5, "discounted_cash": 96.0, "minimum": 93.75, "maximum": 283.4375, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 107.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.47 } ] } ] }, { "description": "Voriconazole Level", "code_information": [ { "code": "80285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.0, "discounted_cash": 74.0, "minimum": 72.0, "maximum": 240.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.0 } ] } ] }, { "description": ".RMSF IgM Titer", "code_information": [ { "code": "86757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.75, "discounted_cash": 118.0, "minimum": 114.525, "maximum": 346.2473, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.37 } ] } ] }, { "description": "NM Lung Perfusion Scan", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 978.5, "discounted_cash": 303.0, "minimum": 293.55, "maximum": 978.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 676.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 916.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 916.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 978.5 } ] } ] }, { "description": "PNH w/ Flaer (High Sensitivity)", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 67.0, "minimum": 64.875, "maximum": 216.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.25 } ] } ] }, { "description": "XR Fluoro Guide Needle Placmnt", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1437.75, "discounted_cash": 445.0, "minimum": 177.98, "maximum": 1304.0393, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 240.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 240.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.6 } ] } ] }, { "description": "NM Parathyrd Planar w SPECT", "code_information": [ { "code": "78071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1404.0, "discounted_cash": 435.0, "minimum": 421.2, "maximum": 1404.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1308.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1404.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1404.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1404.0 } ] } ] }, { "description": "XR ERCP Biliary+Pancreatic", "code_information": [ { "code": "74330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1661.5, "discounted_cash": 515.0, "minimum": 498.45, "maximum": 1506.9805, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 504.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 683.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 683.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.16 } ] } ] }, { "description": "Bill HLA ABC Type", "code_information": [ { "code": "86813", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.25, "discounted_cash": 169.0, "minimum": 164.475, "maximum": 541.6, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 478.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 541.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 370.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 540.65 } ] } ] }, { "description": "MRI Angio Neck wo Contrast", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1524.25, "discounted_cash": 472.0, "minimum": 457.275, "maximum": 1524.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1524.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1524.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1404.36 } ] } ] }, { "description": "Blood Culture", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.25, "discounted_cash": 62.0, "minimum": 60.075, "maximum": 181.6267, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 146.29, "10th_percentile": 146.29, "90th_percentile": 153.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.1, "10th_percentile": 85.05, "90th_percentile": 180.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 130.72, "10th_percentile": 61.69, "90th_percentile": 130.72, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 320.4, "10th_percentile": 320.4, "90th_percentile": 320.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 157.26, "10th_percentile": 151.28, "90th_percentile": 314.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.48, "10th_percentile": 60.48, "90th_percentile": 378.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 77.41, "10th_percentile": 77.41, "90th_percentile": 77.41, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 378.0, "10th_percentile": 189.0, "90th_percentile": 400.5, "count": "48" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.96, "10th_percentile": 64.08, "90th_percentile": 128.16, "count": "52" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 120.96, "10th_percentile": 64.08, "90th_percentile": 363.25, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.96, "10th_percentile": 64.08, "90th_percentile": 128.16, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.96, "10th_percentile": 60.48, "90th_percentile": 128.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.96, "10th_percentile": 120.96, "90th_percentile": 128.16, "count": "1 through 10" } ] } ] }, { "description": "HIV WITH OR WITHOUT OTHER RELATED CONDITION", "code_information": [ { "code": "977", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 30075.4171, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15298.56 } ] } ] }, { "description": "US Bone Density Measurement", "code_information": [ { "code": "76977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.5, "discounted_cash": 75.0, "minimum": 39.4768, "maximum": 219.9475, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.48 } ] } ] }, { "description": "PT Evaluation Units, Low Complexity", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.75, "discounted_cash": 130.0, "minimum": 95.0, "maximum": 381.6202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 189.34, "10th_percentile": 189.34, "90th_percentile": 189.34, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" } ] } ] }, { "description": "Testos Free Male ED/LC-MS/MS", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 357.75, "discounted_cash": 110.0, "minimum": 107.325, "maximum": 324.4792, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 237.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 162.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.42 } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26616.0, "minimum": 26616.72, "maximum": 509081.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 509081.17 } ] } ] }, { "description": "BCR-ABL1 Gene Rearrangment, QN, PCR", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1240.25, "discounted_cash": 384.0, "minimum": 280.77, "maximum": 1240.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 362.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 409.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 280.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1240.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 396.88, "10th_percentile": 396.88, "90th_percentile": 396.88, "count": "1 through 10" } ] } ] }, { "description": "Cholinesterase, Plasma", "code_information": [ { "code": "82482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.0, "discounted_cash": 33.0, "minimum": 32.1, "maximum": 97.049, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.44 } ] } ] }, { "description": "CT Thorax w+wo Contrast", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3145.25, "discounted_cash": 975.0, "minimum": 650.0, "maximum": 2852.7418, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1868.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1868.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1209.78 } ] } ] }, { "description": "MRI Pelvis w Contrast", "code_information": [ { "code": "72196", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 669.0, "minimum": 647.7, "maximum": 2159.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1652.56 } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [ { "code": "963", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 32228.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32228.71 } ] } ] }, { "description": "Uric Acid, Body Fluid", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 38.0, "minimum": 30.36, "maximum": 112.2412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 5.08, "10th_percentile": 5.08, "90th_percentile": 5.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" } ] } ] }, { "description": "H influenza B Ab, IgG", "code_information": [ { "code": "86684", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.5, "discounted_cash": 76.0, "minimum": 62.44, "maximum": 222.6685, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.65 } ] } ] }, { "description": "TX FINGER DISLOC MAN FAC", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.75, "discounted_cash": 105.0, "minimum": 102.525, "maximum": 309.9672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 115.34, "10th_percentile": 115.34, "90th_percentile": 153.79, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 268.38, "10th_percentile": 268.38, "90th_percentile": 268.38, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 341.75, "10th_percentile": 325.5, "90th_percentile": 341.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 109.36, "10th_percentile": 109.36, "90th_percentile": 109.36, "count": "1 through 10" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 46117.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46117.31 } ] } ] }, { "description": "Tricyclic Antidepressants, Urine Qual.", "code_information": [ { "code": "80305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.5, "discounted_cash": 43.0, "minimum": 41.85, "maximum": 126.5265, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.45 } ] } ] }, { "description": "RECTAL RESECTION WITH MCC", "code_information": [ { "code": "332", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13737.0, "minimum": 13737.66, "maximum": 42684.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42684.36 } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC", "code_information": [ { "code": "040", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15454.0, "minimum": 15454.87, "maximum": 45519.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45519.61 } ] } ] }, { "description": "Fungal Culture, Blood", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 63.0, "minimum": 57.7, "maximum": 190.7199, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 190.72 } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [ { "code": "728", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 9563.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9563.22 } ] } ] }, { "description": "CT Guided Soft Tissue Drain Percu", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632.0, "discounted_cash": 195.0, "minimum": 189.6, "maximum": 632.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 632.0 } ] } ] }, { "description": "MA Breast Diag Tomo Right 77065 77061", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.5, "discounted_cash": 124.0, "minimum": 120.45, "maximum": 401.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 307.95, "10th_percentile": 307.95, "90th_percentile": 310.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 180.68, "10th_percentile": 180.68, "90th_percentile": 180.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 384.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.05, "10th_percentile": 131.05, "90th_percentile": 131.05, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 321.36, "10th_percentile": 315.3, "90th_percentile": 321.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.48, "10th_percentile": 128.48, "90th_percentile": 276.32, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 267.0, "10th_percentile": 267.0, "90th_percentile": 267.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 81.89, "10th_percentile": 81.89, "90th_percentile": 81.89, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.48, "10th_percentile": 128.48, "90th_percentile": 128.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 128.48, "10th_percentile": 128.48, "90th_percentile": 364.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.48, "10th_percentile": 128.48, "90th_percentile": 128.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.48, "10th_percentile": 128.48, "90th_percentile": 128.48, "count": "1 through 10" } ] } ] }, { "description": "MRI Brain w Contrast", "code_information": [ { "code": "70552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1801.5, "discounted_cash": 558.0, "minimum": 540.45, "maximum": 1801.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1801.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1801.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1646.89 } ] } ] }, { "description": ".LDL Cholesterol, Direct Reflex", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 31.0, "minimum": 30.9, "maximum": 97.8768, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 58.67 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 78.71, "10th_percentile": 78.71, "90th_percentile": 78.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" } ] } ] }, { "description": "ROM Extremity/Trunk Excluded OT", "code_information": [ { "code": "95851", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.75, "discounted_cash": 20.0, "minimum": 19.425, "maximum": 64.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.75 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC", "code_information": [ { "code": "424", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 25793.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25793.11 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "145", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3434.0, "minimum": 3434.42, "maximum": 14173.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14173.89 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 24608.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24608.32 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [ { "code": "242", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 37639.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37639.86 } ] } ] }, { "description": "SS PAS without Diastase 88313 AP Bill", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.25, "discounted_cash": 55.0, "minimum": 54.075, "maximum": 180.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.25 } ] } ] }, { "description": "REM FB EXT AUD CANAL FAC", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.75, "discounted_cash": 85.0, "minimum": 82.725, "maximum": 250.1053, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 211.5, "10th_percentile": 211.5, "90th_percentile": 211.5, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 216.55, "10th_percentile": 216.55, "90th_percentile": 216.55, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 275.75, "10th_percentile": 262.5, "90th_percentile": 275.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 85.48, "10th_percentile": 85.48, "90th_percentile": 88.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 84.0, "10th_percentile": 84.0, "90th_percentile": 84.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.24, "10th_percentile": 88.24, "90th_percentile": 88.24, "count": "1 through 10" } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES", "code_information": [ { "code": "776", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 7718.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7718.25 } ] } ] }, { "description": "$ AP 88356 Morphometric, Nerve", "code_information": [ { "code": "88356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 945.25, "discounted_cash": 293.0, "minimum": 283.575, "maximum": 945.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 945.25 } ] } ] }, { "description": "CDM US 3D Imaging CPT 76376", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 807.25, "discounted_cash": 250.0, "minimum": 132.5684, "maximum": 732.1757, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 379.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 379.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 807.25, "10th_percentile": 807.25, "90th_percentile": 807.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 644.02, "10th_percentile": 644.02, "90th_percentile": 644.02, "count": "1 through 10" } ] } ] }, { "description": "MA Breast Tomo Lt Scrn 77063 52", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 474.5, "discounted_cash": 147.0, "minimum": 101.4923, "maximum": 430.3715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 315.54, "10th_percentile": 315.54, "90th_percentile": 315.54, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 213.53, "10th_percentile": 213.53, "90th_percentile": 213.53, "count": "84" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 154.88, "10th_percentile": 154.88, "90th_percentile": 154.88, "count": "82" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 142.24 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 301.78, "10th_percentile": 301.78, "90th_percentile": 301.78, "count": "41" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 372.62, "10th_percentile": 372.62, "90th_percentile": 379.79, "count": "53" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 151.84, "10th_percentile": 151.84, "90th_percentile": 151.84, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 315.54, "10th_percentile": 315.54, "90th_percentile": 367.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 34.61, "10th_percentile": 34.09, "90th_percentile": 34.61, "count": "124" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 151.84, "10th_percentile": 151.84, "90th_percentile": 151.84, "count": "249" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 101.36, "10th_percentile": 101.36, "90th_percentile": 101.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.82, "10th_percentile": 50.82, "90th_percentile": 50.82, "count": "151" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 151.84, "10th_percentile": 151.84, "90th_percentile": 151.84, "count": "16" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 151.84, "10th_percentile": 151.84, "90th_percentile": 151.84, "count": "27" } ] } ] }, { "description": "$ Acid EP", "code_information": [ { "code": "83020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.5, "discounted_cash": 57.0, "minimum": 55.95, "maximum": 169.1555, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.97 } ] } ] }, { "description": "Multiple Level Spinal Fusion Except Cervical without MCC", "code_information": [ { "code": "448", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 49994.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49994.71 } ] } ] }, { "description": "CT Neck wo Contrast", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1304.75, "discounted_cash": 404.0, "minimum": 391.425, "maximum": 1183.4082, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1000.74, "10th_percentile": 1000.74, "90th_percentile": 1000.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 985.29, "10th_percentile": 985.29, "90th_percentile": 985.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 792.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1231.0, "10th_percentile": 1231.0, "90th_percentile": 1231.0, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [ { "code": "805", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 12722.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12722.67 } ] } ] }, { "description": "XR Fluoro EGD 74360", "code_information": [ { "code": "74360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1001.0, "discounted_cash": 310.0, "minimum": 300.3, "maximum": 907.907, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 525.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 711.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 711.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.45 } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "464", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 36719.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36719.14 } ] } ] }, { "description": "MRI Femur Left wo Contrast", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1990.75, "discounted_cash": 617.0, "minimum": 597.225, "maximum": 1906.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 895.84, "10th_percentile": 895.84, "90th_percentile": 895.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1410.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1274.08, "10th_percentile": 1274.08, "90th_percentile": 1274.08, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1990.75, "10th_percentile": 1990.75, "90th_percentile": 1990.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 637.04, "10th_percentile": 637.04, "90th_percentile": 637.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 637.04, "10th_percentile": 637.04, "90th_percentile": 637.04, "count": "1 through 10" } ] } ] }, { "description": "MINOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "607", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 10685.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10685.53 } ] } ] }, { "description": "Magnesium Sulfate in Dextrose 5% IV Soln 1 GM/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "63323010800", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 57.91, "10th_percentile": 57.91, "90th_percentile": 173.72, "count": "1 through 10" } ] } ] }, { "description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "761", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3649.0, "minimum": 3649.07, "maximum": 6725.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6725.61 } ] } ] }, { "description": "XR Fistula Sinus Tract Abcess", "code_information": [ { "code": "76080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.5, "discounted_cash": 246.0, "minimum": 144.44, "maximum": 722.4255, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 144.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 195.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.94 } ] } ] }, { "description": "Plasma Hemoglobin", "code_information": [ { "code": "83051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.25, "discounted_cash": 105.0, "minimum": 46.75, "maximum": 308.6067, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.14 } ] } ] }, { "description": "XR Enema Barium", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 321.25, "discounted_cash": 99.0, "minimum": 96.375, "maximum": 321.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 321.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 321.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 321.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 321.25 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "675", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 19350.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19350.43 } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC", "code_information": [ { "code": "522", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 24965.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24965.52 } ] } ] }, { "description": ".C .burnetti IgM Phase I Titer", "code_information": [ { "code": "86638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.25, "discounted_cash": 90.0, "minimum": 77.55, "maximum": 265.9778, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.98 } ] } ] }, { "description": "MRI Lumbar Spine w+wo Contrast", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2606.0, "discounted_cash": 807.0, "minimum": 781.8, "maximum": 2606.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2606.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2606.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 2046.49, "10th_percentile": 2046.49, "90th_percentile": 2046.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1869.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2606.0, "10th_percentile": 2606.0, "90th_percentile": 2606.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 833.92, "10th_percentile": 833.92, "90th_percentile": 833.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 833.92, "10th_percentile": 833.92, "90th_percentile": 833.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 833.92, "10th_percentile": 833.92, "90th_percentile": 833.92, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "577", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 31249.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31249.05 } ] } ] }, { "description": "Eye Culture with Gram Stain", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.5, "discounted_cash": 59.0, "minimum": 55.08, "maximum": 172.7835, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 119.53, "10th_percentile": 95.76, "90th_percentile": 119.53, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.74, "10th_percentile": 64.8, "90th_percentile": 85.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 52.06, "10th_percentile": 49.86, "90th_percentile": 99.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.08 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 114.32, "10th_percentile": 114.32, "90th_percentile": 114.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 119.95, "10th_percentile": 119.95, "90th_percentile": 143.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.66, "10th_percentile": 6.09, "90th_percentile": 144.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 179.75, "10th_percentile": 144.0, "90th_percentile": 190.5, "count": "51" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.88, "10th_percentile": 46.08, "90th_percentile": 57.52, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 138.54, "10th_percentile": 60.96, "90th_percentile": 164.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 46.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 51.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 102.08, "count": "1 through 10" } ] } ] }, { "description": "$ AP 88348 Kidney Electron Microscopy", "code_information": [ { "code": "88348", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1262.0, "discounted_cash": 391.0, "minimum": 378.6, "maximum": 1262.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1262.0 } ] } ] }, { "description": "XR Pelvis 3 Views", "code_information": [ { "code": "72190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.5, "discounted_cash": 152.0, "minimum": 113.78, "maximum": 447.6045, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 154.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 154.07 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 387.55, "10th_percentile": 387.55, "90th_percentile": 387.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 493.5, "10th_percentile": 493.5, "90th_percentile": 493.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 148.96, "10th_percentile": 148.96, "90th_percentile": 148.96, "count": "1 through 10" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CCMCC", "code_information": [ { "code": "060", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 10843.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10843.5 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 10960.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10960.21 } ] } ] }, { "description": "MA US Elastography 1st Lesion 76982", "code_information": [ { "code": "76982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.0, "discounted_cash": 168.0, "minimum": 162.6, "maximum": 542.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.0 } ] } ] }, { "description": "RECTAL RESECTION WITHOUT CCMCC", "code_information": [ { "code": "334", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 19309.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19309.17 } ] } ] }, { "description": ".Myelin Assoc Glycoprotein IgM Ab By Wb", "code_information": [ { "code": "84182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.75, "discounted_cash": 149.0, "minimum": 115.15, "maximum": 436.9472, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.28 } ] } ] }, { "description": "Protein C Antigen", "code_information": [ { "code": "85302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.75, "discounted_cash": 21.0, "minimum": 20.925, "maximum": 69.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.75 } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "407", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 26166.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26166.82 } ] } ] }, { "description": "IV Push Each Addl New Med", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.0, "discounted_cash": 102.0, "minimum": 99.0, "maximum": 299.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 658.35, "10th_percentile": 178.22, "90th_percentile": 1097.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 297.0, "10th_percentile": 148.5, "90th_percentile": 594.0, "count": "33" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 218.59, "10th_percentile": 107.71, "90th_percentile": 218.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 107.71, "10th_percentile": 107.71, "90th_percentile": 323.14, "count": "35" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 1795.86, "10th_percentile": 1795.86, "90th_percentile": 1795.86, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 330.0, "10th_percentile": 19.76, "90th_percentile": 660.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 255.42, "10th_percentile": 224.41, "90th_percentile": 510.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 330.0, "10th_percentile": 330.0, "90th_percentile": 990.0, "count": "229" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.6, "10th_percentile": 105.6, "90th_percentile": 316.8, "count": "86" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 184.42, "10th_percentile": 184.42, "90th_percentile": 184.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.6, "10th_percentile": 105.6, "90th_percentile": 316.8, "count": "74" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.6, "10th_percentile": 105.6, "90th_percentile": 316.8, "count": "32" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 211.2, "10th_percentile": 105.6, "90th_percentile": 211.2, "count": "12" } ] } ] }, { "description": "Maternal Serum Screen Integrated Specimen 2", "code_information": [ { "code": "81511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.25, "discounted_cash": 121.0, "minimum": 117.675, "maximum": 392.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 392.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 392.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 392.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.25 } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [ { "code": "065", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 16402.8565, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11910.41 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 15429.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15429.42 } ] } ] }, { "description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [ { "code": "914", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5366.0, "minimum": 5366.28, "maximum": 10439.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10439.14 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 18882.2489, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 15967.68, "standard_charge_algorithm": "76.7% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 10769.22, "10th_percentile": 10769.22, "90th_percentile": 10769.22, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6504.99, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 45050.99, "10th_percentile": 45050.99, "90th_percentile": 45050.99, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9916.89 } ] } ] }, { "description": "Bill IRL Dilut of Serum Ea Alq", "code_information": [ { "code": "86976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.75, "discounted_cash": 12.0, "minimum": 12.525, "maximum": 41.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.75 } ] } ] }, { "description": "VAP Triglyceride", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 38.0, "minimum": 36.8, "maximum": 112.2412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.8 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 78.71, "10th_percentile": 78.71, "90th_percentile": 78.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 5.74, "10th_percentile": 5.74, "90th_percentile": 5.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "20" } ] } ] }, { "description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC", "code_information": [ { "code": "068", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 10190.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10190.39 } ] } ] }, { "description": "Triiodothyronine (T3), Reverse", "code_information": [ { "code": "84482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.25, "discounted_cash": 53.0, "minimum": 51.675, "maximum": 156.2308, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.4 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 137.87, "10th_percentile": 137.87, "90th_percentile": 137.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 172.25, "10th_percentile": 172.25, "90th_percentile": 172.25, "count": "1 through 10" } ] } ] }, { "description": "Diabetic Ed F/U 30 Min 2-4 ppl - G0109 - 1253308", "code_information": [ { "code": "G0109", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.75, "minimum": 16.5, "maximum": 68.7053, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.28, "10th_percentile": 73.28, "90th_percentile": 73.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.28, "10th_percentile": 54.72, "90th_percentile": 109.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.28, "10th_percentile": 73.28, "90th_percentile": 109.92, "count": "1 through 10" } ] } ] }, { "description": "AVULS NAIL PLT SIMP 1 FAC", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.5, "discounted_cash": 91.0, "minimum": 88.35, "maximum": 267.1115, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 94.24, "10th_percentile": 94.24, "90th_percentile": 94.24, "count": "1 through 10" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [ { "code": "974", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14166.0, "minimum": 14166.97, "maximum": 34023.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34023.0 } ] } ] }, { "description": "Blood product/irradiation", "code_information": [ { "code": "86945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.75, "discounted_cash": 42.0, "minimum": 41.325, "maximum": 137.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.75 } ] } ] }, { "description": "99195 PHLEBOTOMY THERAP S", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.5, "discounted_cash": 125.0, "minimum": 121.05, "maximum": 365.9745, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 267.28, "10th_percentile": 261.17, "90th_percentile": 267.28, "count": "14" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.7, "10th_percentile": 131.7, "90th_percentile": 131.7, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 129.12, "10th_percentile": 122.96, "90th_percentile": 129.12, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 129.12, "10th_percentile": 129.12, "90th_percentile": 129.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 129.12, "10th_percentile": 129.12, "90th_percentile": 129.12, "count": "1 through 10" } ] } ] }, { "description": "MRI Orbit and or Face w+wo Contrast", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2647.75, "discounted_cash": 820.0, "minimum": 794.325, "maximum": 2647.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2647.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2647.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2098.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2647.75, "10th_percentile": 2647.75, "90th_percentile": 2647.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 761.67, "10th_percentile": 761.67, "90th_percentile": 847.28, "count": "1 through 10" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "344", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14810.0, "minimum": 14810.92, "maximum": 30448.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30448.58 } ] } ] }, { "description": "MRI TM Joints Bilat wo 70336", "code_information": [ { "code": "70336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 918.75, "discounted_cash": 284.0, "minimum": 275.625, "maximum": 918.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 918.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 918.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 918.75 } ] } ] }, { "description": "NM Inj Non Imaging Probe Study", "code_information": [ { "code": "78808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 799.75, "discounted_cash": 247.0, "minimum": 173.61, "maximum": 725.3732, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 173.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 235.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 235.07 } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "856", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19533.0, "minimum": 19533.24, "maximum": 53624.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53624.53 } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "820", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22967.0, "minimum": 22967.66, "maximum": 69140.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69140.01 } ] } ] }, { "description": ".MOG Antiobody Titer Serum", "code_information": [ { "code": "86362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2012.0, "discounted_cash": 623.0, "minimum": 112.3253, "maximum": 1824.884, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.33 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 77516.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77516.08 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "315", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 11356.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11356.32 } ] } ] }, { "description": "MRI Sacrum wo 72195", "code_information": [ { "code": "72195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2153.5, "discounted_cash": 667.0, "minimum": 646.05, "maximum": 1953.2245, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 551.62, "10th_percentile": 551.62, "90th_percentile": 551.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1412.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1690.0, "10th_percentile": 1690.0, "90th_percentile": 1690.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 540.8, "10th_percentile": 540.8, "90th_percentile": 540.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 689.12, "10th_percentile": 689.12, "90th_percentile": 689.12, "count": "1 through 10" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16742.0, "minimum": 16742.78, "maximum": 42034.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42034.79 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [ { "code": "155", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 5394.6584, "maximum": 10804.6, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6280.68, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7969.27, "10th_percentile": 7969.27, "90th_percentile": 7969.27, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10804.6 } ] } ] }, { "description": "Aspartate Aminotransferase", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.5, "discounted_cash": 16.0, "minimum": 16.05, "maximum": 48.5245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 35.58, "10th_percentile": 35.58, "90th_percentile": 35.58, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.08, "10th_percentile": 24.08, "90th_percentile": 24.08, "count": "41" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.46, "10th_percentile": 17.46, "90th_percentile": 17.46, "count": "37" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.08 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 34.03, "10th_percentile": 34.03, "90th_percentile": 34.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 42.82, "10th_percentile": 42.01, "90th_percentile": 42.82, "count": "17" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.5, "10th_percentile": 48.95, "90th_percentile": 53.5, "count": "37" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 10.34, "10th_percentile": 10.34, "90th_percentile": 41.03, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 53.5, "10th_percentile": 53.5, "90th_percentile": 53.5, "count": "80" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 17.12, "count": "191" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 42.68, "10th_percentile": 17.12, "90th_percentile": 49.01, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 17.12, "count": "85" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 17.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 17.12, "count": "23" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 20239.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20239.32 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 13165.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13165.93 } ] } ] }, { "description": "Urine Potassium", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.5, "discounted_cash": 24.0, "minimum": 23.25, "maximum": 70.2925, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.09 } ] } ] }, { "description": "Lactate Dehydrogenase 1", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 57.0, "minimum": 55.5, "maximum": 167.795, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.22 } ] } ] }, { "description": "CT Cervical Spine w+wo Contrast", "code_information": [ { "code": "72127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1528.0, "discounted_cash": 473.0, "minimum": 458.4, "maximum": 1528.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1528.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1528.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1212.65 } ] } ] }, { "description": "NM Shunt Ventricular Patency", "code_information": [ { "code": "78645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 662.75, "discounted_cash": 205.0, "minimum": 198.825, "maximum": 662.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 662.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 662.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 662.75 } ] } ] }, { "description": "BCR-ABL1 Qualitiative Reflex Quant", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1240.25, "discounted_cash": 384.0, "minimum": 280.77, "maximum": 1240.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 362.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 409.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 280.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1240.25 } ] } ] }, { "description": "NM Parathyrd w SPECT + CT", "code_information": [ { "code": "78072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1405.0, "discounted_cash": 435.0, "minimum": 421.5, "maximum": 1405.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1381.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1405.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1405.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1405.0 } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "969", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25114.0, "minimum": 25114.17, "maximum": 72163.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72163.88 } ] } ] }, { "description": "Free Kappa Light Chains, Urine", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.75, "discounted_cash": 42.0, "minimum": 40.725, "maximum": 126.7738, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 229.14, "10th_percentile": 229.14, "90th_percentile": 229.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.44, "10th_percentile": 134.44, "90th_percentile": 134.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.51, "10th_percentile": 97.51, "90th_percentile": 97.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.6 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 190.01, "10th_percentile": 190.01, "90th_percentile": 190.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 298.75, "10th_percentile": 298.75, "90th_percentile": 597.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.6, "10th_percentile": 92.61, "90th_percentile": 95.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 95.6, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 95.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 95.6, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 5322.8164, "maximum": 14193.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14193.93 } ] } ] }, { "description": "Blood Urea Nitrogen", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.25, "discounted_cash": 18.0, "minimum": 17.475, "maximum": 52.8327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.21, "10th_percentile": 26.21, "90th_percentile": 26.21, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.01, "10th_percentile": 19.01, "90th_percentile": 19.01, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.25, "10th_percentile": 58.25, "90th_percentile": 58.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 58.25, "10th_percentile": 58.25, "90th_percentile": 58.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 3.95, "90th_percentile": 18.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 52.83, "10th_percentile": 18.64, "90th_percentile": 52.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 52.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 18.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 18.64, "count": "1 through 10" } ] } ] }, { "description": "Morphine Sulfate IV Soln PF 4 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641612525", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.03, "10th_percentile": 6.03, "90th_percentile": 6.03, "count": "1 through 10" } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "988", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8586.04, "maximum": 19376.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19376.37 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 18413.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18413.21 } ] } ] }, { "description": "$ AP 88319 Group III stains", "code_information": [ { "code": "88319", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 56.0, "minimum": 54.9, "maximum": 183.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.0 } ] } ] }, { "description": "XR Shoulder Left 1 View", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.5, "discounted_cash": 108.0, "minimum": 62.74, "maximum": 318.8105, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 331.5, "10th_percentile": 331.5, "90th_percentile": 331.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 303.65, "10th_percentile": 303.65, "90th_percentile": 303.65, "count": "1 through 10" } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [ { "code": "243", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 25121.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25121.14 } ] } ] }, { "description": "INJ ANES TRIGEM FAC", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 905.75, "discounted_cash": 280.0, "minimum": 271.725, "maximum": 821.5153, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 905.75, "10th_percentile": 862.5, "90th_percentile": 905.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 722.61, "10th_percentile": 722.61, "90th_percentile": 722.61, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 289.84, "10th_percentile": 289.84, "90th_percentile": 289.84, "count": "1 through 10" } ] } ] }, { "description": "Blood Parasite, Tick-Borne", "code_information": [ { "code": "87207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.5, "discounted_cash": 23.0, "minimum": 22.65, "maximum": 68.4785, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 47.38, "10th_percentile": 47.38, "90th_percentile": 47.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 23.26, "10th_percentile": 23.26, "90th_percentile": 24.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.34 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 48.02, "10th_percentile": 45.32, "90th_percentile": 90.64, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 59.29, "10th_percentile": 59.29, "90th_percentile": 59.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 75.5, "10th_percentile": 71.25, "90th_percentile": 75.5, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.16, "10th_percentile": 22.8, "90th_percentile": 24.16, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 24.16, "10th_percentile": 24.16, "90th_percentile": 68.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.16, "10th_percentile": 24.16, "90th_percentile": 24.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 24.16, "10th_percentile": 22.8, "90th_percentile": 24.16, "count": "1 through 10" } ] } ] }, { "description": "LUNG TRANSPLANT", "code_information": [ { "code": "007", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42286.0, "minimum": 42286.25, "maximum": 152669.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 152669.65 } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 13494.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13494.85 } ] } ] }, { "description": "IR Venogram Vena Cava Superior", "code_information": [ { "code": "75827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2245.75, "discounted_cash": 696.0, "minimum": 558.3443, "maximum": 2036.8953, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 834.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1129.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1129.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 558.34 } ] } ] }, { "description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [ { "code": "789", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 21246.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21246.1 } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CCMCC", "code_information": [ { "code": "458", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 49190.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49190.7 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "252", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11376.0, "minimum": 11376.5, "maximum": 41123.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41123.5 } ] } ] }, { "description": "Bill Chr Anal Amniotic Fl Culture", "code_information": [ { "code": "88235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 886.0, "discounted_cash": 274.0, "minimum": 265.8, "maximum": 886.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 725.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 821.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 562.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 886.0 } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC", "code_information": [ { "code": "579", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16098.0, "minimum": 16098.83, "maximum": 38178.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38178.61 } ] } ] }, { "description": "TX TALUS FX MANI FAC", "code_information": [ { "code": "28435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1806.25, "discounted_cash": 559.0, "minimum": 541.875, "maximum": 1638.2687, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1806.25, "10th_percentile": 1806.25, "90th_percentile": 1806.25, "count": "1 through 10" } ] } ] }, { "description": "MRI Forearm Left wo Contrast", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1868.75, "discounted_cash": 579.0, "minimum": 560.625, "maximum": 1868.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1868.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1868.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1868.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1868.75, "10th_percentile": 1868.75, "90th_percentile": 1868.75, "count": "1 through 10" } ] } ] }, { "description": "Bill IRL Incu w Inhib per Aliq", "code_information": [ { "code": "86977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.5, "discounted_cash": 45.0, "minimum": 43.65, "maximum": 145.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.5 } ] } ] }, { "description": "Urine Culture", "code_information": [ { "code": "87088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 45.0, "minimum": 43.95, "maximum": 132.8755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 91.94, "10th_percentile": 91.94, "90th_percentile": 112.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.93, "10th_percentile": 62.21, "90th_percentile": 65.93, "count": "78" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 47.82, "10th_percentile": 45.12, "90th_percentile": 47.82, "count": "51" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.79 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 93.17, "10th_percentile": 87.93, "90th_percentile": 93.17, "count": "27" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 115.05, "10th_percentile": 110.66, "90th_percentile": 115.05, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 126.71, "10th_percentile": 11.02, "90th_percentile": 146.5, "count": "32" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 112.37, "10th_percentile": 91.94, "90th_percentile": 112.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 146.5, "10th_percentile": 138.25, "90th_percentile": 146.5, "count": "204" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.88, "10th_percentile": 8.09, "90th_percentile": 46.88, "count": "226" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 75.41, "10th_percentile": 75.41, "90th_percentile": 75.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.88, "10th_percentile": 44.24, "90th_percentile": 176.52, "count": "92" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.24, "10th_percentile": 8.09, "90th_percentile": 46.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.88, "10th_percentile": 44.24, "90th_percentile": 46.88, "count": "21" } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "623", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11161.0, "minimum": 11161.85, "maximum": 21148.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21148.25 } ] } ] }, { "description": "PTT", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.75, "discounted_cash": 36.0, "minimum": 35.025, "maximum": 105.8923, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 73.32, "10th_percentile": 73.32, "90th_percentile": 73.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 52.54, "10th_percentile": 49.61, "90th_percentile": 52.54, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.99, "10th_percentile": 35.99, "90th_percentile": 38.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.38 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 95.62, "10th_percentile": 95.62, "90th_percentile": 95.62, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 88.24, "10th_percentile": 88.24, "90th_percentile": 88.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 90.57, "10th_percentile": 90.57, "90th_percentile": 110.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 116.75, "10th_percentile": 110.25, "90th_percentile": 116.75, "count": "46" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.36, "10th_percentile": 35.28, "90th_percentile": 37.36, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 87.96, "10th_percentile": 37.36, "90th_percentile": 106.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.36, "10th_percentile": 35.28, "90th_percentile": 37.36, "count": "49" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.36, "10th_percentile": 35.28, "90th_percentile": 37.36, "count": "13" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.36, "10th_percentile": 35.28, "90th_percentile": 37.36, "count": "1 through 10" } ] } ] }, { "description": "Lactate", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.0, "discounted_cash": 43.0, "minimum": 41.7, "maximum": 126.073, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 92.44, "10th_percentile": 92.44, "90th_percentile": 92.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 62.55, "10th_percentile": 62.55, "90th_percentile": 125.1, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.37, "10th_percentile": 45.37, "90th_percentile": 90.74, "count": "29" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.31 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 222.4, "10th_percentile": 111.2, "90th_percentile": 227.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 111.26, "10th_percentile": 109.16, "90th_percentile": 222.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 139.0, "10th_percentile": 44.48, "90th_percentile": 139.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 26.87, "10th_percentile": 26.87, "90th_percentile": 107.59, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 139.0, "10th_percentile": 139.0, "90th_percentile": 278.0, "count": "99" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 88.96, "count": "76" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 110.89, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 88.96, "count": "47" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 88.96, "count": "20" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 44.48, "count": "1 through 10" } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "947", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 23757.1651, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7942.09, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8450.12, "10th_percentile": 6394.65, "90th_percentile": 49025.65, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14964.93 } ] } ] }, { "description": "US Transrectal", "code_information": [ { "code": "76872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.0, "discounted_cash": 193.0, "minimum": 187.2, "maximum": 624.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 535.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 535.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.0 } ] } ] }, { "description": "MRI Lumbar Spine wo Contrast", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2134.75, "discounted_cash": 661.0, "minimum": 640.425, "maximum": 1936.2182, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1652.3, "10th_percentile": 1637.35, "90th_percentile": 1652.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 960.64, "10th_percentile": 960.64, "90th_percentile": 960.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 696.78, "10th_percentile": 696.78, "90th_percentile": 696.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1676.42, "10th_percentile": 1676.42, "90th_percentile": 1708.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1074.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 321.02, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1419.61, "10th_percentile": 1419.61, "90th_percentile": 1652.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2134.75, "10th_percentile": 2134.75, "90th_percentile": 2134.75, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "156", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 8147.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8147.36 } ] } ] }, { "description": "Carboxyhemoglobin", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.5, "discounted_cash": 54.0, "minimum": 52.95, "maximum": 160.0855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 117.37, "10th_percentile": 117.37, "90th_percentile": 117.37, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 101.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 176.5, "10th_percentile": 176.5, "90th_percentile": 176.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 56.48, "count": "1 through 10" } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj 1000 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009069801", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 42.86, "10th_percentile": 42.86, "90th_percentile": 42.86, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 52.1, "10th_percentile": 52.1, "90th_percentile": 52.1, "count": "1 through 10" } ] } ] }, { "description": "NASAL HEMORR ANT SIM FAC", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 363.5, "discounted_cash": 112.0, "minimum": 109.05, "maximum": 329.6945, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 163.58, "10th_percentile": 163.58, "90th_percentile": 163.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.65, "10th_percentile": 118.65, "90th_percentile": 118.65, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 110.8, "10th_percentile": 110.8, "90th_percentile": 110.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 116.32, "10th_percentile": 116.32, "90th_percentile": 116.32, "count": "1 through 10" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 25856.9956, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6729.3, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 93060.68, "10th_percentile": 93060.68, "90th_percentile": 93060.68, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12060.13 } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [ { "code": "125", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 9051.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9051.58 } ] } ] }, { "description": "XR Arthrogram Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 762.0, "discounted_cash": 236.0, "minimum": 228.6, "maximum": 691.134, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 375.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 375.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 631.7 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11591.0, "minimum": 11591.15, "maximum": 37042.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37042.15 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11591.0, "minimum": 11591.15, "maximum": 62868.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62868.27 } ] } ] }, { "description": "IR Ureters or Urethral Dilation 74485", "code_information": [ { "code": "74485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8110.5, "discounted_cash": 2514.0, "minimum": 364.69, "maximum": 7356.2235, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 364.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 493.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 685.24 } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CCMCC", "code_information": [ { "code": "355", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 15856.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15856.18 } ] } ] }, { "description": "U Cystine 24HR", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.25, "discounted_cash": 59.0, "minimum": 57.675, "maximum": 192.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.25 } ] } ] }, { "description": "Vaginal Screen, Candida sp", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.5, "discounted_cash": 20.0, "minimum": 19.65, "maximum": 65.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 41.06, "10th_percentile": 41.06, "90th_percentile": 50.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.79, "10th_percentile": 27.79, "90th_percentile": 29.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.16, "10th_percentile": 20.16, "90th_percentile": 20.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 41.66, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 51.44, "10th_percentile": 49.42, "90th_percentile": 51.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 50.24, "10th_percentile": 50.24, "90th_percentile": 50.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 65.5, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "63" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.05, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 56.56, "10th_percentile": 49.26, "90th_percentile": 59.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.76, "10th_percentile": 19.76, "90th_percentile": 19.76, "count": "1 through 10" } ] } ] }, { "description": "RAD ULNAR SHAFT FX FAC", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.75, "discounted_cash": 109.0, "minimum": 106.425, "maximum": 321.7582, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 272.09, "10th_percentile": 272.09, "90th_percentile": 272.09, "count": "1 through 10" } ] } ] }, { "description": "IR Dilitation Biliary Duct S+I", "code_information": [ { "code": "74363", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1748.0, "discounted_cash": 541.0, "minimum": 341.35, "maximum": 1585.436, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 341.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 462.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 462.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.17 } ] } ] }, { "description": "Phenytoin, Free", "code_information": [ { "code": "80186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.25, "discounted_cash": 15.0, "minimum": 15.375, "maximum": 51.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.25 } ] } ] }, { "description": "CU TSH", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.5, "discounted_cash": 65.0, "minimum": 63.45, "maximum": 191.8305, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 166.09, "10th_percentile": 166.09, "90th_percentile": 169.28, "count": "54" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 211.5, "10th_percentile": 93.85, "90th_percentile": 211.5, "count": "84" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 162.22, "10th_percentile": 40.88, "90th_percentile": 162.22, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 211.5, "10th_percentile": 211.5, "90th_percentile": 211.5, "count": "393" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "356" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 191.83, "10th_percentile": 67.68, "90th_percentile": 193.74, "count": "75" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "188" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "29" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "23" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 140.65, "10th_percentile": 140.65, "90th_percentile": 140.65, "count": "27" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.18, "10th_percentile": 95.18, "90th_percentile": 95.18, "count": "106" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.03, "10th_percentile": 69.03, "90th_percentile": 69.03, "count": "86" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.48 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 134.51, "10th_percentile": 134.51, "90th_percentile": 134.51, "count": "1 through 10" } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [ { "code": "485", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17386.0, "minimum": 17386.73, "maximum": 38044.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38044.22 } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 8800.69, "maximum": 11092.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11092.25 } ] } ] }, { "description": "SLP Non-Speech AAC Device Tx Units", "code_information": [ { "code": "92606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.5, "discounted_cash": 158.0, "minimum": 95.0, "maximum": 463.0235, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "88309 AP Bill Surgical Pathology Level VI Complexity", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 679.0, "discounted_cash": 210.0, "minimum": 203.7, "maximum": 679.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 679.0 } ] } ] }, { "description": "Tube #1 Nucleated Cells", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.5, "discounted_cash": 41.0, "minimum": 30.23, "maximum": 120.1775, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 125.0, "10th_percentile": 125.0, "90th_percentile": 125.0, "count": "1 through 10" } ] } ] }, { "description": "IGF-1 (Insulin-Like Growth Factor 1)", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 63.0, "minimum": 61.2, "maximum": 198.1772, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.14 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 160.2, "10th_percentile": 160.2, "90th_percentile": 160.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 204.0, "10th_percentile": 204.0, "90th_percentile": 204.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.28, "10th_percentile": 65.28, "90th_percentile": 65.28, "count": "1 through 10" } ] } ] }, { "description": "XR Sacroiliac Joints Min 3 Views", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.0, "discounted_cash": 136.0, "minimum": 100.68, "maximum": 398.173, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 320.63, "10th_percentile": 320.63, "90th_percentile": 320.63, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 263.46, "10th_percentile": 263.46, "90th_percentile": 279.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 140.48, "10th_percentile": 140.48, "90th_percentile": 140.48, "count": "1 through 10" } ] } ] }, { "description": "99283 - Level 3", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 859.25, "discounted_cash": 266.0, "minimum": 257.775, "maximum": 859.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 496.92, "10th_percentile": 496.92, "90th_percentile": 659.04, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 386.66, "10th_percentile": 336.26, "90th_percentile": 386.66, "count": "94" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 859.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 859.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 280.46, "10th_percentile": 243.9, "90th_percentile": 280.46, "count": "87" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 859.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 528.19, "10th_percentile": 254.08, "90th_percentile": 703.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 674.77, "10th_percentile": 598.1, "90th_percentile": 674.77, "count": "39" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 596.16, "10th_percentile": 596.16, "90th_percentile": 596.16, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 336.94, "10th_percentile": 80.56, "90th_percentile": 747.25, "count": "105" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 659.04, "10th_percentile": 496.92, "90th_percentile": 659.04, "count": "13" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 859.25, "10th_percentile": 747.25, "90th_percentile": 859.25, "count": "1075" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 274.96, "count": "236" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 684.48, "10th_percentile": 480.18, "90th_percentile": 779.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 502.24, "count": "203" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 239.12, "10th_percentile": 239.12, "90th_percentile": 274.96, "count": "102" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 274.96, "count": "42" } ] } ] }, { "description": "MOUTH PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "138", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3434.0, "minimum": 3434.42, "maximum": 10447.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10447.39 } ] } ] }, { "description": "XR Knees AP Standing", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.25, "discounted_cash": 96.0, "minimum": 83.16, "maximum": 283.2108, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.74 } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [ { "code": "001", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55379.0, "minimum": 55379.96, "maximum": 330373.2, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 330373.2 } ] } ] }, { "description": "IR Hepatic Portogram wo Press 75885", "code_information": [ { "code": "75885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7643.0, "discounted_cash": 2369.0, "minimum": 611.959, "maximum": 6932.201, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 846.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1145.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1145.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 611.96 } ] } ] }, { "description": "Fungal Culture, Tissue or Fluids", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 52.0, "minimum": 50.625, "maximum": 153.0563, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 72.82, "10th_percentile": 72.82, "90th_percentile": 72.82, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 53.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 109.5, "10th_percentile": 109.5, "90th_percentile": 109.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 8.41, "10th_percentile": 8.41, "90th_percentile": 8.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 54.0, "10th_percentile": 54.0, "90th_percentile": 54.0, "count": "1 through 10" } ] } ] }, { "description": "Contrast Baths/15M PT", "code_information": [ { "code": "97034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.75, "discounted_cash": 32.0, "minimum": 31.125, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Lyme Ab Total by ELISA", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.5, "discounted_cash": 75.0, "minimum": 72.75, "maximum": 219.9475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 152.12, "10th_percentile": 152.12, "90th_percentile": 152.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.66, "10th_percentile": 74.66, "90th_percentile": 79.15, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.44 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 154.23, "10th_percentile": 145.49, "90th_percentile": 290.98, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 190.44, "10th_percentile": 190.44, "90th_percentile": 190.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 242.5, "10th_percentile": 228.75, "90th_percentile": 242.5, "count": "44" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 77.6, "10th_percentile": 73.2, "90th_percentile": 77.6, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 193.47, "10th_percentile": 77.6, "90th_percentile": 219.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.2, "10th_percentile": 73.2, "90th_percentile": 77.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 77.6, "10th_percentile": 73.2, "90th_percentile": 77.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" } ] } ] }, { "description": "RAD HD SUBLUX CHILD FAC", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 428.75, "discounted_cash": 132.0, "minimum": 128.625, "maximum": 388.8763, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 336.7, "10th_percentile": 336.7, "90th_percentile": 336.7, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 428.75, "10th_percentile": 428.75, "90th_percentile": 428.75, "count": "1 through 10" } ] } ] }, { "description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [ { "code": "887", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 12624.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12624.82 } ] } ] }, { "description": ".Hexagonal Phase Confirm", "code_information": [ { "code": "85598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.75, "discounted_cash": 30.0, "minimum": 28.79, "maximum": 99.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 99.75, "10th_percentile": 99.75, "90th_percentile": 99.75, "count": "1 through 10" } ] } ] }, { "description": "Galactose-Alpha-1,3 Galactose (Alpha -Gal IgE)", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.5, "discounted_cash": 12.0, "minimum": 11.85, "maximum": 39.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.5 } ] } ] }, { "description": "Folate, RBC", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.0, "discounted_cash": 64.0, "minimum": 62.1, "maximum": 187.749, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 164.53 } ] } ] }, { "description": "Streptococcus Group A Screen", "code_information": [ { "code": "87880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 31.0, "minimum": 30.6, "maximum": 102.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 64.01, "10th_percentile": 64.01, "90th_percentile": 64.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 13.95, "10th_percentile": 13.95, "90th_percentile": 13.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 31.42, "10th_percentile": 9.55, "90th_percentile": 33.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 83.54, "10th_percentile": 78.83, "90th_percentile": 83.54, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 80.1, "10th_percentile": 80.1, "90th_percentile": 80.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 31.0, "10th_percentile": 31.0, "90th_percentile": 31.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 78.23, "10th_percentile": 78.23, "90th_percentile": 78.23, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 31.0, "10th_percentile": 29.25, "90th_percentile": 102.0, "count": "217" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 9.36, "10th_percentile": 9.36, "90th_percentile": 32.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 57.0, "10th_percentile": 57.0, "90th_percentile": 57.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 74.6, "10th_percentile": 30.8, "90th_percentile": 243.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.64, "10th_percentile": 30.8, "90th_percentile": 32.64, "count": "1 through 10" } ] } ] }, { "description": "Pyruvate Level", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.75, "discounted_cash": 92.0, "minimum": 69.45, "maximum": 270.0593, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.98 } ] } ] }, { "description": "75736 FAC PELVIC ANGIOGM SELECTIVE", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.75, "discounted_cash": 2034.0, "minimum": 781.1357, "maximum": 5952.4142, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 924.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1252.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1252.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 781.14 } ] } ] }, { "description": "Proinsulin Level", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.25, "discounted_cash": 63.0, "minimum": 61.275, "maximum": 204.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 204.25, "10th_percentile": 204.25, "90th_percentile": 204.25, "count": "1 through 10" } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "352", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 13767.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13767.17 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16098.0, "minimum": 16098.83, "maximum": 71471.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71471.87 } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "822", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 14193.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14193.93 } ] } ] }, { "description": "88104 AP Bill Non-Gyn Cytology", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.5, "discounted_cash": 28.0, "minimum": 27.45, "maximum": 91.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.5 } ] } ] }, { "description": "Reducing Substances, Fecal", "code_information": [ { "code": "84376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.5, "discounted_cash": 9.0, "minimum": 9.45, "maximum": 31.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "1 through 10" } ] } ] }, { "description": "XR Chest 4+ Views 71048", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 488.0, "discounted_cash": 151.0, "minimum": 104.84, "maximum": 442.616, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 232.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 232.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.07 } ] } ] }, { "description": "PT Evaluation Units, Moderate Complexity", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.75, "discounted_cash": 130.0, "minimum": 95.0, "maximum": 381.6202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 189.34, "10th_percentile": 189.34, "90th_percentile": 189.34, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 409.28, "10th_percentile": 409.28, "90th_percentile": 409.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.64, "10th_percentile": 26.93, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 22742.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22742.12 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [ { "code": "841", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8586.0, "minimum": 8570.6546, "maximum": 19232.54, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8586.04, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12789.3, "10th_percentile": 12789.3, "90th_percentile": 12789.3, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19232.54 } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 1361.107, "maximum": 7855.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7855.0 } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "830", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 17742.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17742.41 } ] } ] }, { "description": "Blood Gas (No Metabolites) Capillary", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.75, "discounted_cash": 106.0, "minimum": 102.825, "maximum": 342.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 265.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 111.87, "10th_percentile": 111.87, "90th_percentile": 111.87, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 181.53 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 274.2, "10th_percentile": 274.2, "90th_percentile": 280.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 183.1, "10th_percentile": 84.77, "90th_percentile": 342.75, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 262.89, "10th_percentile": 262.89, "90th_percentile": 262.89, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 342.75, "10th_percentile": 342.75, "90th_percentile": 685.5, "count": "46" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 109.68, "count": "34" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 310.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 109.68, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 219.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 109.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 227.93, "10th_percentile": 227.93, "90th_percentile": 227.93, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 154.24, "10th_percentile": 154.24, "90th_percentile": 154.24, "count": "1 through 10" } ] } ] }, { "description": "CH50-Total Complement", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.25, "discounted_cash": 78.0, "minimum": 75.675, "maximum": 228.7908, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 189.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 252.25, "10th_percentile": 252.25, "90th_percentile": 252.25, "count": "1 through 10" } ] } ] }, { "description": "ED OB US LIMITED FETUS(S) FAC", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.25, "discounted_cash": 168.0, "minimum": 162.675, "maximum": 491.8207, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 418.91, "10th_percentile": 418.91, "90th_percentile": 418.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.64 } ] } ] }, { "description": "Stool Additional Pathogen, each plate", "code_information": [ { "code": "87046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.25, "discounted_cash": 8.0, "minimum": 7.875, "maximum": 26.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 38.31, "10th_percentile": 38.31, "90th_percentile": 40.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 41.23, "10th_percentile": 41.23, "90th_percentile": 41.23, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 52.5, "10th_percentile": 49.5, "90th_percentile": 52.5, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.8, "10th_percentile": 15.84, "90th_percentile": 18.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 15.84, "10th_percentile": 15.84, "90th_percentile": 16.8, "count": "1 through 10" } ] } ] }, { "description": "IR Radiopharm TX 79445", "code_information": [ { "code": "79445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 728.75, "discounted_cash": 225.0, "minimum": 218.625, "maximum": 728.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 409.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 555.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 555.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 728.75 } ] } ] }, { "description": "NM Spleen Scan", "code_information": [ { "code": "78185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.5, "discounted_cash": 195.0, "minimum": 189.15, "maximum": 630.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 630.5 } ] } ] }, { "description": "NASAL HEMORR ANT COMPLEX FAC", "code_information": [ { "code": "30903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 367.0, "discounted_cash": 113.0, "minimum": 110.1, "maximum": 332.869, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 117.44, "10th_percentile": 117.44, "90th_percentile": 117.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 117.44, "10th_percentile": 117.44, "90th_percentile": 117.44, "count": "1 through 10" } ] } ] }, { "description": "Alpha-1-Antitrypsin Level", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.5, "discounted_cash": 50.0, "minimum": 48.75, "maximum": 147.3875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 73.13, "10th_percentile": 73.13, "90th_percentile": 73.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 162.5, "10th_percentile": 162.5, "90th_percentile": 162.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 52.0, "10th_percentile": 52.0, "90th_percentile": 52.0, "count": "1 through 10" } ] } ] }, { "description": "75822 FAC VENOGRAPHY EXT BILATERAL", "code_information": [ { "code": "75822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2650.75, "discounted_cash": 821.0, "minimum": 367.64, "maximum": 2404.2303, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 497.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 497.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 555.54 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "741", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 16812.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16812.26 } ] } ] }, { "description": "Haloperidol Lactate Inj 5 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323047400", "type": "NDC" }, { "code": "J1630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 16.19, "10th_percentile": 16.19, "90th_percentile": 16.19, "count": "1 through 10" } ] } ] }, { "description": "Hematocrit, Body Fluid", "code_information": [ { "code": "85013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.25, "discounted_cash": 18.0, "minimum": 15.16, "maximum": 58.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.25 } ] } ] }, { "description": "OTA MMT, Total Body Without Hand Units", "code_information": [ { "code": "95833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.0, "discounted_cash": 40.0, "minimum": 39.3, "maximum": 118.817, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "XR SMB Via Enteroclysis", "code_information": [ { "code": "74251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1105.0, "discounted_cash": 342.0, "minimum": 331.5, "maximum": 1105.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 577.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 782.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 782.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1105.0 } ] } ] }, { "description": "Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.75, "discounted_cash": 75.0, "minimum": 73.425, "maximum": 221.9882, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.24 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 195.9, "10th_percentile": 195.9, "90th_percentile": 195.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 244.75, "10th_percentile": 244.75, "90th_percentile": 244.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 78.32, "10th_percentile": 78.32, "90th_percentile": 78.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 78.32, "10th_percentile": 78.32, "90th_percentile": 78.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 78.32, "10th_percentile": 78.32, "90th_percentile": 78.32, "count": "1 through 10" } ] } ] }, { "description": "XR Mandible 4 Views", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 528.5, "discounted_cash": 163.0, "minimum": 106.5, "maximum": 479.3495, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.74 } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [ { "code": "769", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 19921.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19921.02 } ] } ] }, { "description": "Sodium, Stool", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.0, "discounted_cash": 21.0, "minimum": 21.0, "maximum": 63.49, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.3 } ] } ] }, { "description": "Trichrome Stain, Stool", "code_information": [ { "code": "87177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.25, "discounted_cash": 44.0, "minimum": 42.675, "maximum": 129.0207, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 103.91, "10th_percentile": 103.91, "90th_percentile": 103.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.41, "10th_percentile": 60.41, "90th_percentile": 60.41, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.82, "10th_percentile": 43.82, "90th_percentile": 46.43, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56.92 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 90.47, "10th_percentile": 90.47, "90th_percentile": 90.47, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 111.71, "10th_percentile": 111.71, "90th_percentile": 111.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 142.25, "10th_percentile": 134.25, "90th_percentile": 142.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 8.9, "10th_percentile": 8.9, "90th_percentile": 42.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 45.52, "10th_percentile": 45.52, "90th_percentile": 45.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.96, "10th_percentile": 42.96, "90th_percentile": 45.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 91.04, "10th_percentile": 91.04, "90th_percentile": 91.04, "count": "1 through 10" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 13597.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13597.41 } ] } ] }, { "description": "OT Biofeedback Training addl 15 min", "code_information": [ { "code": "90913", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.5, "discounted_cash": 25.0, "minimum": 25.05, "maximum": 83.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.5 } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "578", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 18937.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18937.82 } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "093", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 37999.3954, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9387.56 } ] } ] }, { "description": "99281 - Level 1 - Lynx Visit Level", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.75, "discounted_cash": 78.0, "minimum": 75.525, "maximum": 251.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 145.64, "10th_percentile": 145.64, "90th_percentile": 145.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 113.29, "10th_percentile": 113.29, "90th_percentile": 113.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 251.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 251.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 251.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 206.18, "10th_percentile": 206.18, "90th_percentile": 206.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 200.85, "10th_percentile": 200.85, "90th_percentile": 200.85, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 84.86, "10th_percentile": 70.08, "90th_percentile": 96.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 251.75, "10th_percentile": 219.0, "90th_percentile": 251.75, "count": "29" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 80.56, "10th_percentile": 70.08, "90th_percentile": 80.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 200.85, "10th_percentile": 200.85, "90th_percentile": 200.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 80.56, "10th_percentile": 70.08, "90th_percentile": 80.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 70.08, "10th_percentile": 70.08, "90th_percentile": 80.56, "count": "1 through 10" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "821", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 26390.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26390.81 } ] } ] }, { "description": "Von Willebrand Factor Multimer Assay", "code_information": [ { "code": "85247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.0, "discounted_cash": 119.0, "minimum": 116.1, "maximum": 351.009, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 214.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.84 } ] } ] }, { "description": "IgA (Immunoglobulin A)", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.75, "discounted_cash": 30.0, "minimum": 29.925, "maximum": 90.4732, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 67.5, "10th_percentile": 67.5, "90th_percentile": 67.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 100.46, "10th_percentile": 45.68, "90th_percentile": 155.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.74, "10th_percentile": 39.74, "90th_percentile": 72.87, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 47.58 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 64.55, "10th_percentile": 64.55, "90th_percentile": 77.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 121.75, "10th_percentile": 101.5, "90th_percentile": 223.25, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.96, "10th_percentile": 32.48, "90th_percentile": 71.44, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 110.43, "10th_percentile": 110.43, "90th_percentile": 110.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.96, "10th_percentile": 32.48, "90th_percentile": 71.44, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.96, "10th_percentile": 38.96, "90th_percentile": 71.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.96, "10th_percentile": 38.96, "90th_percentile": 71.44, "count": "1 through 10" } ] } ] }, { "description": "NM Cerebrospinal Fluid Leakage", "code_information": [ { "code": "78650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 990.0, "discounted_cash": 306.0, "minimum": 297.0, "maximum": 990.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 990.0 } ] } ] }, { "description": "Growth Hormone", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.5, "discounted_cash": 69.0, "minimum": 67.65, "maximum": 204.5285, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 137.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 155.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.39 } ] } ] }, { "description": "Toxoplasmosis Ab, IgG", "code_information": [ { "code": "86777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 34.0, "minimum": 33.3, "maximum": 111.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.0 } ] } ] }, { "description": "CT Angiography Chest w+wo Contrast", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2105.0, "discounted_cash": 652.0, "minimum": 631.5, "maximum": 1927.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 947.25, "10th_percentile": 446.8, "90th_percentile": 947.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1927.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 648.15, "10th_percentile": 648.15, "90th_percentile": 687.07, "count": "19" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1927.96 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1589.39, "10th_percentile": 1589.39, "90th_percentile": 1589.39, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1723.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2105.0, "10th_percentile": 1985.75, "90th_percentile": 2105.0, "count": "32" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 635.44, "10th_percentile": 635.44, "90th_percentile": 673.6, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 673.6, "10th_percentile": 635.44, "90th_percentile": 1909.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 673.6, "10th_percentile": 635.44, "90th_percentile": 673.6, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 673.6, "10th_percentile": 635.44, "90th_percentile": 673.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 635.44, "10th_percentile": 635.44, "90th_percentile": 673.6, "count": "1 through 10" } ] } ] }, { "description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [ { "code": "951", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 9236.8197, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 3863.72, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9166.32, "10th_percentile": 9166.32, "90th_percentile": 9166.32, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6554.67 } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "858", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 16420.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16420.87 } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "383", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 16277.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16277.04 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CCMCC", "code_information": [ { "code": "729", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 12480.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12480.99 } ] } ] }, { "description": "17-Hydroxyprogesterone Quantitative - 83498 - 3358335 - 3358335", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.25, "discounted_cash": 68.0, "minimum": 66.075, "maximum": 220.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 220.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 173.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 220.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 220.25, "10th_percentile": 220.25, "90th_percentile": 220.25, "count": "1 through 10" } ] } ] }, { "description": "FAC REMOVE IMPCTD EAR WAX UNI", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.25, "discounted_cash": 86.0, "minimum": 84.075, "maximum": 254.1867, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 126.11, "10th_percentile": 126.11, "90th_percentile": 126.11, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 267.0, "10th_percentile": 267.0, "90th_percentile": 280.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 89.68, "10th_percentile": 89.68, "90th_percentile": 89.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 89.68, "10th_percentile": 89.68, "90th_percentile": 89.68, "count": "1 through 10" } ] } ] }, { "description": ".dRVVT Confirm", "code_information": [ { "code": "85597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.75, "discounted_cash": 51.0, "minimum": 29.88, "maximum": 165.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 165.75, "10th_percentile": 165.75, "90th_percentile": 165.75, "count": "1 through 10" } ] } ] }, { "description": "Antibody Screen (Automated)", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.75, "discounted_cash": 51.0, "minimum": 50.025, "maximum": 151.2423, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 127.9, "10th_percentile": 127.9, "90th_percentile": 129.06, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 75.04, "10th_percentile": 75.04, "90th_percentile": 75.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.43, "10th_percentile": 54.43, "90th_percentile": 54.43, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 136.57, "10th_percentile": 136.57, "90th_percentile": 136.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 133.47, "10th_percentile": 133.47, "90th_percentile": 133.47, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 166.75, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 110.89, "10th_percentile": 110.89, "90th_percentile": 110.89, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 166.75, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 151.24, "10th_percentile": 53.36, "90th_percentile": 152.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "49" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "1 through 10" } ] } ] }, { "description": "Galectin-3, Serum", "code_information": [ { "code": "82777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.5, "discounted_cash": 91.0, "minimum": 77.99, "maximum": 294.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 294.5 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 17611.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17611.56 } ] } ] }, { "description": "XR Toes Min Left 2 Views", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.0, "discounted_cash": 91.0, "minimum": 81.71, "maximum": 268.472, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 91.15, "10th_percentile": 91.15, "90th_percentile": 91.15, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 296.0, "10th_percentile": 279.25, "90th_percentile": 296.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 94.72, "10th_percentile": 94.72, "90th_percentile": 94.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 94.72, "10th_percentile": 94.72, "90th_percentile": 94.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 94.72, "10th_percentile": 94.72, "90th_percentile": 94.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 94.72, "10th_percentile": 94.72, "90th_percentile": 94.72, "count": "1 through 10" } ] } ] }, { "description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [ { "code": "175", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 7781.8327, "maximum": 16193.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16193.34 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CCMCC", "code_information": [ { "code": "244", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 21308.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21308.58 } ] } ] }, { "description": "XR Abdomen 2 Views 74019", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.25, "discounted_cash": 190.0, "minimum": 88.83, "maximum": 558.0317, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 261.23, "10th_percentile": 261.23, "90th_percentile": 276.86, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 185.34 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 475.43, "10th_percentile": 475.43, "90th_percentile": 475.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 449.9, "10th_percentile": 449.9, "90th_percentile": 449.9, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 615.25, "10th_percentile": 580.5, "90th_percentile": 615.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 196.88, "10th_percentile": 196.88, "90th_percentile": 196.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 196.88, "10th_percentile": 196.88, "90th_percentile": 473.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 185.76, "10th_percentile": 185.76, "90th_percentile": 185.76, "count": "1 through 10" } ] } ] }, { "description": "XR Cervical Spine Flex+Ext+Obl", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 684.75, "discounted_cash": 212.0, "minimum": 186.71, "maximum": 621.0683, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 252.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 252.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 408.91 } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC", "code_information": [ { "code": "353", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12235.0, "minimum": 12235.11, "maximum": 34211.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34211.62 } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 15113.47, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8371.39, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6439.53, "10th_percentile": 6439.53, "90th_percentile": 6439.53, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15113.47 } ] } ] }, { "description": "Mixed Blood Gas", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.25, "discounted_cash": 92.0, "minimum": 89.475, "maximum": 270.5127, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 243.01 } ] } ] }, { "description": "$ Fact13 Mix", "code_information": [ { "code": "85291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.5, "discounted_cash": 38.0, "minimum": 37.35, "maximum": 112.9215, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.92 } ] } ] }, { "description": "NM VCUG", "code_information": [ { "code": "78740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 803.5, "discounted_cash": 249.0, "minimum": 241.05, "maximum": 803.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 691.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 803.5 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [ { "code": "336", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 24859.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24859.42 } ] } ] }, { "description": "85097 AP Bill Bone Marrow Aspiration", "code_information": [ { "code": "85097", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.5, "discounted_cash": 80.0, "minimum": 77.55, "maximum": 258.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.5 } ] } ] }, { "description": "Ultrasound Guidance Needle Placement", "code_information": [ { "code": "76942", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.0, "discounted_cash": 244.0, "minimum": 236.4, "maximum": 788.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 605.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 788.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.73 } ] } ] }, { "description": "$ COVID/FLU Combo", "code_information": [ { "code": "87636", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 454.5, "discounted_cash": 140.0, "minimum": 136.35, "maximum": 454.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 285.12, "10th_percentile": 285.12, "90th_percentile": 285.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 192.94, "10th_percentile": 192.94, "90th_percentile": 204.53, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 428.75, "10th_percentile": 114.1, "90th_percentile": 454.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 139.94, "10th_percentile": 139.94, "90th_percentile": 148.35, "count": "39" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 363.6, "10th_percentile": 351.15, "90th_percentile": 372.24, "count": "21" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 343.17, "10th_percentile": 343.17, "90th_percentile": 356.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 454.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 137.2, "10th_percentile": 137.2, "90th_percentile": 390.6, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 87.85, "10th_percentile": 87.85, "90th_percentile": 348.6, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 99.84, "10th_percentile": 99.84, "90th_percentile": 99.84, "count": "315" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 137.2, "10th_percentile": 137.2, "90th_percentile": 145.44, "count": "67" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 392.74, "10th_percentile": 145.44, "90th_percentile": 412.23, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 145.44, "10th_percentile": 137.2, "90th_percentile": 145.44, "count": "57" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 137.2, "10th_percentile": 137.2, "90th_percentile": 145.44, "count": "36" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 137.2, "10th_percentile": 137.2, "90th_percentile": 145.44, "count": "18" } ] } ] }, { "description": "CT Neck w Contrast", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2107.25, "discounted_cash": 653.0, "minimum": 632.175, "maximum": 1911.2758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1322.02, "10th_percentile": 1322.02, "90th_percentile": 1322.02, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 894.6, "10th_percentile": 474.13, "90th_percentile": 948.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1441.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 648.88, "10th_percentile": 648.88, "90th_percentile": 687.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1441.98 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1654.82, "10th_percentile": 1591.2, "90th_percentile": 1654.82, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1051.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 580.91, "10th_percentile": 580.91, "90th_percentile": 673.47, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2107.25, "10th_percentile": 1988.0, "90th_percentile": 2107.25, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 636.16, "10th_percentile": 636.16, "90th_percentile": 674.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 674.32, "10th_percentile": 636.16, "90th_percentile": 1930.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 636.16, "10th_percentile": 225.0, "90th_percentile": 674.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 674.32, "10th_percentile": 636.16, "90th_percentile": 674.32, "count": "1 through 10" } ] } ] }, { "description": "GC, Amplified DNA", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.25, "discounted_cash": 36.0, "minimum": 35.475, "maximum": 118.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 74.15, "10th_percentile": 74.15, "90th_percentile": 90.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.21, "10th_percentile": 50.18, "90th_percentile": 53.21, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 118.25, "10th_percentile": 118.25, "90th_percentile": 118.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 75.21, "10th_percentile": 70.91, "90th_percentile": 94.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 89.24, "10th_percentile": 89.24, "90th_percentile": 92.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.25 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 74.15, "10th_percentile": 74.15, "90th_percentile": 90.7, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 118.25, "10th_percentile": 111.5, "90th_percentile": 118.25, "count": "113" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 102.13, "10th_percentile": 88.95, "90th_percentile": 107.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.84, "10th_percentile": 37.84, "90th_percentile": 37.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 35.68, "10th_percentile": 35.68, "90th_percentile": 35.68, "count": "1 through 10" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15240.0, "minimum": 15240.22, "maximum": 32904.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32904.22 } ] } ] }, { "description": "NM Venous Thrombosis Bilateral", "code_information": [ { "code": "78458", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.5, "discounted_cash": 273.0, "minimum": 265.05, "maximum": 883.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 644.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 873.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 873.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 883.5 } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CCMCC", "code_information": [ { "code": "013", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13952.0, "minimum": 13952.32, "maximum": 33973.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33973.48 } ] } ] }, { "description": "CT Guided Needle Biopsy-Aspiration", "code_information": [ { "code": "77012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1778.75, "discounted_cash": 551.0, "minimum": 533.625, "maximum": 1613.3263, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 570.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 772.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 772.37 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.82 } ] } ] }, { "description": "Leptospira Antibody, IgM by Dot Blot", "code_information": [ { "code": "86720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.25, "discounted_cash": 76.0, "minimum": 55.6, "maximum": 224.2558, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.01 } ] } ] }, { "description": "LAMBDA ISH 88364 Bill", "code_information": [ { "code": "88364", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 99.0, "minimum": 96.0, "maximum": 320.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.0 } ] } ] }, { "description": "CT Guided Tissue Ablation", "code_information": [ { "code": "77013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.0, "discounted_cash": 118.0, "minimum": 114.3, "maximum": 381.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 381.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 381.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 381.0 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15240.0, "minimum": 15240.22, "maximum": 67554.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67554.39 } ] } ] }, { "description": "Estradiol Lvl", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.5, "discounted_cash": 108.0, "minimum": 105.15, "maximum": 317.9035, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 266.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 301.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 206.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 301.09 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "987", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16742.0, "minimum": 16742.78, "maximum": 40417.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40417.34 } ] } ] }, { "description": "XR Hip Right 1 View w Pelvis", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.25, "discounted_cash": 108.0, "minimum": 105.075, "maximum": 317.6768, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 330.5, "10th_percentile": 330.5, "90th_percentile": 350.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 112.08, "10th_percentile": 112.08, "90th_percentile": 112.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 224.16, "10th_percentile": 224.16, "90th_percentile": 224.16, "count": "1 through 10" } ] } ] }, { "description": "Primidone Level", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.5, "discounted_cash": 42.0, "minimum": 40.95, "maximum": 136.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 136.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.2, "10th_percentile": 41.2, "90th_percentile": 43.68, "count": "1 through 10" } ] } ] }, { "description": "BD DXA Bone Density Axial Skeleton w VFA", "code_information": [ { "code": "77085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.5, "discounted_cash": 139.0, "minimum": 135.45, "maximum": 409.5105, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 227.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 332.75 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 3723.0685, "maximum": 10835.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10835.25 } ] } ] }, { "description": "Herpesvirus 6 DNA, QL RT PCR", "code_information": [ { "code": "87532", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 99.0, "minimum": 96.0, "maximum": 320.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.0 } ] } ] }, { "description": "Meningitis/Encephalitis PCR Panel, CSF", "code_information": [ { "code": "87483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.25, "discounted_cash": 220.0, "minimum": 213.375, "maximum": 711.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 711.25 } ] } ] }, { "description": "74176 FAC CT ABD PELVIS WO CONTRAST", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1932.5, "discounted_cash": 599.0, "minimum": 579.75, "maximum": 1752.7775, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1281.16, "10th_percentile": 1191.73, "90th_percentile": 1345.7, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 699.19, "10th_percentile": 659.59, "90th_percentile": 789.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 766.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 572.67, "10th_percentile": 478.42, "90th_percentile": 1080.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 766.45 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1220.16, "10th_percentile": 1220.16, "90th_percentile": 1220.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 899.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 469.04, "10th_percentile": 174.26, "90th_percentile": 884.16, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1553.75, "10th_percentile": 1465.75, "90th_percentile": 1754.5, "count": "36" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 497.2, "10th_percentile": 469.04, "90th_percentile": 561.44, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1239.58, "10th_percentile": 529.68, "90th_percentile": 1591.33, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 561.44, "10th_percentile": 497.2, "90th_percentile": 561.44, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 529.68, "10th_percentile": 469.04, "90th_percentile": 561.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 561.44, "10th_percentile": 561.44, "90th_percentile": 561.44, "count": "1 through 10" } ] } ] }, { "description": "Urine Calcium", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.75, "discounted_cash": 27.0, "minimum": 26.625, "maximum": 80.4963, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.11 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 56.45, "10th_percentile": 56.45, "90th_percentile": 56.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [ { "code": "551", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 20096.263, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19759.51 } ] } ] }, { "description": "SLP Eval of Voice and Resonance Units", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 362.5, "discounted_cash": 112.0, "minimum": 95.0, "maximum": 328.7875, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "205", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 4885.4954, "maximum": 21585.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21585.62 } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "653", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20391.0, "minimum": 20391.85, "maximum": 61260.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61260.26 } ] } ] }, { "description": "US Doppler Veloc Fetal Mid Cerebral Art", "code_information": [ { "code": "76821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.25, "discounted_cash": 128.0, "minimum": 123.975, "maximum": 413.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 343.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 413.25 } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [ { "code": "064", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 6656.4935, "maximum": 23707.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23707.64 } ] } ] }, { "description": "SYNCOPE AND COLLAPSE", "code_information": [ { "code": "312", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 30798.1041, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5151.62, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 55420.3, "10th_percentile": 55420.3, "90th_percentile": 55420.3, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10275.27 } ] } ] }, { "description": "Chromosome Analysis Amniotic Fluid", "code_information": [ { "code": "88269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 738.25, "discounted_cash": 228.0, "minimum": 221.475, "maximum": 738.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 738.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 738.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 738.25 } ] } ] }, { "description": "88143 AP Bill Gyn Liquid Prep Manual Rescreen", "code_information": [ { "code": "88143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.75, "discounted_cash": 45.0, "minimum": 43.725, "maximum": 145.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 129.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.75 } ] } ] }, { "description": "Fluoxetine Level", "code_information": [ { "code": "80332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "discounted_cash": 28.0, "minimum": 27.375, "maximum": 91.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.25 } ] } ] }, { "description": "Whirlpool Therapy OT", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.75, "discounted_cash": 38.0, "minimum": 36.825, "maximum": 111.3342, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Acid Elution", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 566.0, "discounted_cash": 175.0, "minimum": 169.8, "maximum": 513.362, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 350.21 } ] } ] }, { "description": "PTH Intact - Sendout", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.5, "discounted_cash": 83.0, "minimum": 81.15, "maximum": 270.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 207.47, "10th_percentile": 207.47, "90th_percentile": 207.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.29, "10th_percentile": 88.29, "90th_percentile": 88.29, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 264.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 172.04, "10th_percentile": 172.04, "90th_percentile": 172.04, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 212.42, "10th_percentile": 212.42, "90th_percentile": 216.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 207.92, "10th_percentile": 121.6, "90th_percentile": 243.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 270.5, "10th_percentile": 270.5, "90th_percentile": 270.5, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 86.56, "count": "38" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 490.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 86.56, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 86.56, "count": "1 through 10" } ] } ] }, { "description": "HIV 1,2 Ab - 86703 - 3358933", "code_information": [ { "code": "86703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "discounted_cash": 28.0, "minimum": 27.375, "maximum": 91.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 58.04, "10th_percentile": 58.04, "90th_percentile": 58.04, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 68.83, "10th_percentile": 68.83, "90th_percentile": 68.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 69.99, "10th_percentile": 69.99, "90th_percentile": 69.99, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 91.25, "10th_percentile": 86.0, "90th_percentile": 91.25, "count": "37" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 82.76, "10th_percentile": 78.78, "90th_percentile": 82.76, "count": "1 through 10" } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "507", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10947.0, "minimum": 10947.2, "maximum": 21295.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21295.61 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12020.0, "minimum": 12020.46, "maximum": 30406.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30406.14 } ] } ] }, { "description": "XR Scoliosis 4-5 Views 72083", "code_information": [ { "code": "72083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 541.75, "discounted_cash": 167.0, "minimum": 162.525, "maximum": 530.2051, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.21 } ] } ] }, { "description": "MRI Ankle Left w+wo Contrast", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "discounted_cash": 930.0, "minimum": 900.0, "maximum": 2949.2, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2949.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 979.44, "10th_percentile": 979.44, "90th_percentile": 979.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2949.2 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2504.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 931.76, "10th_percentile": 931.76, "90th_percentile": 1016.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 3000.75, "10th_percentile": 3000.75, "90th_percentile": 3000.75, "count": "1 through 10" } ] } ] }, { "description": "THA DISLOC WO ANES FAC", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.75, "discounted_cash": 115.0, "minimum": 111.825, "maximum": 338.0842, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.28, "10th_percentile": 119.28, "90th_percentile": 119.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.28, "10th_percentile": 119.28, "90th_percentile": 119.28, "count": "1 through 10" } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [ { "code": "948", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5580.0, "minimum": 5580.93, "maximum": 27109.021, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 5580.93, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10657.75, "10th_percentile": 10657.75, "90th_percentile": 10657.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 5832.06, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8266.69, "10th_percentile": 3227.37, "90th_percentile": 36969.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5580.93, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12789.3, "10th_percentile": 6394.65, "90th_percentile": 31973.25, "count": "13" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9437.08 } ] } ] }, { "description": "88332 AP Bill Frozen addl block", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.75, "discounted_cash": 35.0, "minimum": 34.425, "maximum": 114.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.75 } ] } ] }, { "description": "LYR CLSR 12.6-20 FAC", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 173.0, "minimum": 167.625, "maximum": 506.7862, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 251.44, "10th_percentile": 251.44, "90th_percentile": 251.44, "count": "1 through 10" } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [ { "code": "844", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7942.0, "minimum": 7942.09, "maximum": 14351.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14351.9 } ] } ] }, { "description": "Homovanillic Acid, 24 hr Urine", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 459.5, "discounted_cash": 142.0, "minimum": 123.78, "maximum": 416.7665, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.9 } ] } ] }, { "description": "Coronary Risk Panel", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 61.0, "minimum": 59.4, "maximum": 179.586, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 124.19, "10th_percentile": 119.2, "90th_percentile": 124.19, "count": "29" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 85.5, "10th_percentile": 84.04, "90th_percentile": 89.1, "count": "211" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 62.02, "10th_percentile": 60.96, "90th_percentile": 64.63, "count": "140" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 125.93, "10th_percentile": 114.0, "90th_percentile": 125.93, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 149.47, "10th_percentile": 149.21, "90th_percentile": 155.49, "count": "84" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.36, "10th_percentile": 23.14, "90th_percentile": 186.75, "count": "71" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 151.87, "10th_percentile": 38.27, "90th_percentile": 151.87, "count": "13" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 13.39, "10th_percentile": 13.39, "90th_percentile": 13.39, "count": "468" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 61.38, "10th_percentile": 59.76, "90th_percentile": 63.36, "count": "497" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 171.06, "10th_percentile": 63.36, "90th_percentile": 179.59, "count": "105" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.8, "10th_percentile": 59.76, "90th_percentile": 63.36, "count": "332" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 59.76, "10th_percentile": 57.36, "90th_percentile": 63.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.36, "10th_percentile": 59.76, "90th_percentile": 63.36, "count": "59" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [ { "code": "193", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 15495.44, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 13457.07, "standard_charge_algorithm": "80% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12094.79, "10th_percentile": 12094.79, "90th_percentile": 12094.79, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8748.09, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 16750.28, "10th_percentile": 14237.41, "90th_percentile": 26746.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8371.39, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2464.12, "10th_percentile": 2291.58, "90th_percentile": 16041.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8371.39, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9192.0, "10th_percentile": 9192.0, "90th_percentile": 9192.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15495.44 } ] } ] }, { "description": "75605 FAC THORACIC AORTOGRAM", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6666.25, "discounted_cash": 2066.0, "minimum": 578.0827, "maximum": 6046.2887, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 876.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1187.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1187.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.08 } ] } ] }, { "description": "Hgb Elect", "code_information": [ { "code": "83021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.25, "discounted_cash": 25.0, "minimum": 24.675, "maximum": 82.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 82.25, "10th_percentile": 82.25, "90th_percentile": 217.5, "count": "1 through 10" } ] } ] }, { "description": "Factor IX Activity", "code_information": [ { "code": "85250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 578.5, "discounted_cash": 179.0, "minimum": 121.76, "maximum": 524.6995, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 157.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 367.53, "10th_percentile": 367.53, "90th_percentile": 367.53, "count": "1 through 10" } ] } ] }, { "description": "DRVVT (Patient)", "code_information": [ { "code": "85613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 29.0, "minimum": 28.2, "maximum": 89.3009, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 226.0, "10th_percentile": 226.0, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.08, "10th_percentile": 30.08, "90th_percentile": 30.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" } ] } ] }, { "description": "XR Knee Left 3 Views", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.5, "discounted_cash": 139.0, "minimum": 97.72, "maximum": 409.5105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 283.29, "10th_percentile": 283.29, "90th_percentile": 283.29, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 191.7, "10th_percentile": 191.7, "90th_percentile": 203.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 139.05, "10th_percentile": 139.05, "90th_percentile": 147.37, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 132.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 348.89, "10th_percentile": 287.15, "90th_percentile": 361.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 354.56, "10th_percentile": 354.56, "90th_percentile": 354.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 451.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 132.32, "10th_percentile": 132.32, "90th_percentile": 132.32, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 451.5, "10th_percentile": 426.0, "90th_percentile": 451.5, "count": "58" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 144.48, "count": "50" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 390.22, "10th_percentile": 136.32, "90th_percentile": 819.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 273.13, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 144.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.32, "10th_percentile": 136.32, "90th_percentile": 144.48, "count": "1 through 10" } ] } ] }, { "description": "CSF Cry Ag", "code_information": [ { "code": "87327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.75, "discounted_cash": 200.0, "minimum": 73.3, "maximum": 586.6023, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.1 } ] } ] }, { "description": "Aspergillus Ab-CF", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.25, "discounted_cash": 64.0, "minimum": 62.775, "maximum": 189.7897, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.29 } ] } ] }, { "description": "VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION ANDOR D&C", "code_information": [ { "code": "768", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 12633.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12633.07 } ] } ] }, { "description": "CO2", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 11.0, "minimum": 11.325, "maximum": 37.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 16.99, "10th_percentile": 16.99, "90th_percentile": 16.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 37.75, "10th_percentile": 37.75, "90th_percentile": 37.75, "count": "1 through 10" } ] } ] }, { "description": "EXCISION NAIL FOLD FAC", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.0, "discounted_cash": 94.0, "minimum": 91.2, "maximum": 275.728, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.28, "10th_percentile": 97.28, "90th_percentile": 97.28, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17816.0, "minimum": 17816.03, "maximum": 84060.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84060.14 } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [ { "code": "124", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 15598.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15598.0 } ] } ] }, { "description": "ED US EXAM PELVIC LIMITED FAC", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.25, "discounted_cash": 168.0, "minimum": 162.675, "maximum": 491.8207, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 343.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.79 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 9397.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9397.0 } ] } ] }, { "description": "Folate Level", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 45.0, "minimum": 43.95, "maximum": 137.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 97.42, "10th_percentile": 97.42, "90th_percentile": 97.42, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 65.93, "10th_percentile": 65.93, "90th_percentile": 65.93, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 47.82, "10th_percentile": 47.82, "90th_percentile": 47.82, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.07 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 115.05, "10th_percentile": 115.05, "90th_percentile": 117.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.9, "10th_percentile": 37.9, "90th_percentile": 146.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 112.37, "10th_percentile": 112.37, "90th_percentile": 112.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 146.5, "10th_percentile": 146.5, "90th_percentile": 146.5, "count": "66" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "63" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 132.88, "10th_percentile": 46.88, "90th_percentile": 134.19, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "40" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "1 through 10" } ] } ] }, { "description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [ { "code": "604", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 17354.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17354.56 } ] } ] }, { "description": "75746 FAC PULMONARY NONSELECTIVE", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2069.75, "discounted_cash": 641.0, "minimum": 620.925, "maximum": 1877.2632, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 894.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1210.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1210.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.18 } ] } ] }, { "description": "Chromium, Blood", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.5, "discounted_cash": 33.0, "minimum": 31.95, "maximum": 106.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.5 } ] } ] }, { "description": "CT Thoracic Spine w+wo Contrast", "code_information": [ { "code": "72130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.5, "discounted_cash": 538.0, "minimum": 520.65, "maximum": 1735.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1735.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1735.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1221.12 } ] } ] }, { "description": "US Obstetrical Multi 14- Wk", "code_information": [ { "code": "76802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 331.5, "discounted_cash": 102.0, "minimum": 99.45, "maximum": 300.6705, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 179.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 179.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.65 } ] } ] }, { "description": "PT Evaluation Units, High Complexity", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.75, "discounted_cash": 130.0, "minimum": 95.0, "maximum": 381.6202, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" } ] } ] }, { "description": "Hgb", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.75, "discounted_cash": 11.0, "minimum": 11.025, "maximum": 33.3323, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.69, "10th_percentile": 15.64, "90th_percentile": 31.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.0, "10th_percentile": 11.34, "90th_percentile": 26.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 20.25, "10th_percentile": 19.0, "90th_percentile": 36.75, "count": "58" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.76, "10th_percentile": 11.12, "90th_percentile": 11.76, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 31.83, "10th_percentile": 31.83, "90th_percentile": 31.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.76, "10th_percentile": 11.12, "90th_percentile": 13.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "count": "1 through 10" } ] } ] }, { "description": "Glucose, 3 Hour Gestational", "code_information": [ { "code": "82952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.5, "discounted_cash": 17.0, "minimum": 16.65, "maximum": 50.3385, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.54 } ] } ] }, { "description": "CT Heart w+wo Dye Funct", "code_information": [ { "code": "75572", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1451.25, "discounted_cash": 449.0, "minimum": 435.375, "maximum": 1316.2838, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 973.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 973.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1288.8 } ] } ] }, { "description": "XR Arthrogram Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 578.25, "discounted_cash": 179.0, "minimum": 173.475, "maximum": 578.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 316.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 428.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 428.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.25 } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "663", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 17921.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17921.61 } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 894.2756, "maximum": 9520.78, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6224.88, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6874.74, "10th_percentile": 6874.74, "90th_percentile": 6874.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9520.78 } ] } ] }, { "description": "Prostatic Acid Phosphatase", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 67.0, "minimum": 61.78, "maximum": 196.1387, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 79.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 61.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.05 } ] } ] }, { "description": "Beta Lactamase", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 9.0, "minimum": 9.3, "maximum": 31.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.12, "10th_percentile": 10.12, "90th_percentile": 10.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 9.36, "10th_percentile": 9.36, "90th_percentile": 9.36, "count": "1 through 10" } ] } ] }, { "description": "CT Thorax wo Contrast Low Dose 71250", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1968.5, "discounted_cash": 610.0, "minimum": 590.55, "maximum": 1785.4295, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1126.84, "10th_percentile": 1126.84, "90th_percentile": 1126.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 808.31, "10th_percentile": 762.53, "90th_percentile": 808.31, "count": "24" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 586.3, "10th_percentile": 553.08, "90th_percentile": 586.3, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1410.6, "10th_percentile": 1356.28, "90th_percentile": 1410.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 724.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 574.8, "count": "14" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1796.25, "10th_percentile": 1694.5, "90th_percentile": 1796.25, "count": "40" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 574.8, "count": "58" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 1552.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 574.8, "count": "43" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 574.8, "count": "24" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 574.8, "count": "1 through 10" } ] } ] }, { "description": "Selenium, Blood Level", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.5, "discounted_cash": 86.0, "minimum": 83.25, "maximum": 251.6925, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 238.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 163.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.8, "10th_percentile": 88.8, "90th_percentile": 88.8, "count": "1 through 10" } ] } ] }, { "description": "CT Facial Bones w Contrast", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1582.75, "discounted_cash": 490.0, "minimum": 474.825, "maximum": 1493.36, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1493.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 516.61, "10th_percentile": 516.61, "90th_percentile": 516.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1493.36 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1582.75, "10th_percentile": 1582.75, "90th_percentile": 1582.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 477.84, "10th_percentile": 477.84, "90th_percentile": 506.48, "count": "1 through 10" } ] } ] }, { "description": "NM Dose Sestamibi", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.75, "minimum": 97.725, "maximum": 325.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.75 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "853", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19962.0, "minimum": 19962.54, "maximum": 58221.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58221.06 } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [ { "code": "436", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 13334.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13334.52 } ] } ] }, { "description": "Absolute CD19", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.0, "discounted_cash": 59.0, "minimum": 57.3, "maximum": 191.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.83, "10th_percentile": 58.83, "90th_percentile": 58.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 180.25, "10th_percentile": 180.25, "90th_percentile": 180.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 61.12, "10th_percentile": 61.12, "90th_percentile": 61.12, "count": "1 through 10" } ] } ] }, { "description": "Urine Osmolality", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.5, "discounted_cash": 47.0, "minimum": 43.6, "maximum": 139.2245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.08, "10th_percentile": 69.08, "90th_percentile": 69.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.6 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 120.54, "10th_percentile": 120.54, "90th_percentile": 120.54, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 129.42, "10th_percentile": 129.42, "90th_percentile": 129.42, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 153.5, "10th_percentile": 153.5, "90th_percentile": 153.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 49.12, "10th_percentile": 49.12, "90th_percentile": 49.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 49.12, "10th_percentile": 49.12, "90th_percentile": 49.12, "count": "1 through 10" } ] } ] }, { "description": "88304 AP Bill Surgical Pathology Level III Complexity", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.0, "discounted_cash": 92.0, "minimum": 89.1, "maximum": 297.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 227.8, "10th_percentile": 227.8, "90th_percentile": 227.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 196.73, "10th_percentile": 161.51, "90th_percentile": 201.87, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 96.94, "10th_percentile": 96.94, "90th_percentile": 96.94, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 243.24, "10th_percentile": 243.24, "90th_percentile": 243.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 237.72, "10th_percentile": 237.72, "90th_percentile": 237.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 297.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 297.0, "10th_percentile": 297.0, "90th_percentile": 297.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.04, "10th_percentile": 95.04, "90th_percentile": 95.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 272.05, "10th_percentile": 272.05, "90th_percentile": 272.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.04, "10th_percentile": 95.04, "90th_percentile": 95.04, "count": "1 through 10" } ] } ] }, { "description": "CK (Creatine Kinase)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.5, "discounted_cash": 41.0, "minimum": 40.35, "maximum": 121.9915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 104.1, "10th_percentile": 103.16, "90th_percentile": 104.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.53, "10th_percentile": 60.53, "90th_percentile": 60.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.9, "10th_percentile": 43.9, "90th_percentile": 43.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 134.5, "10th_percentile": 134.5, "90th_percentile": 134.5, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.04, "10th_percentile": 6.51, "90th_percentile": 43.04, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 123.21, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 43.04, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 43.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 43.04, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "573", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25758.0, "minimum": 25758.12, "maximum": 77234.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77234.32 } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12449.0, "minimum": 12449.76, "maximum": 23180.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23180.67 } ] } ] }, { "description": "Protein Electrophoresis, 24-Hour Urine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.5, "discounted_cash": 24.0, "minimum": 24.15, "maximum": 73.0135, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 53.53, "10th_percentile": 53.53, "90th_percentile": 53.53, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.23, "10th_percentile": 36.23, "90th_percentile": 36.23, "count": "37" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 26.28, "10th_percentile": 26.28, "90th_percentile": 26.28, "count": "39" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 51.2, "10th_percentile": 51.2, "90th_percentile": 51.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 64.43, "10th_percentile": 63.22, "90th_percentile": 64.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 80.5, "10th_percentile": 3.07, "90th_percentile": 80.5, "count": "20" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 61.74, "10th_percentile": 53.53, "90th_percentile": 61.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 80.5, "10th_percentile": 80.5, "90th_percentile": 80.5, "count": "67" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 51.52, "count": "137" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 73.74, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 51.52, "count": "62" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 25.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 25.76, "count": "25" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12449.0, "minimum": 12449.76, "maximum": 30562.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30562.93 } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "576", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18889.0, "minimum": 18889.29, "maximum": 57780.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57780.15 } ] } ] }, { "description": "HIV-1,2 Confirmation", "code_information": [ { "code": "86689", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 259.75, "discounted_cash": 80.0, "minimum": 77.925, "maximum": 235.5933, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.37 } ] } ] }, { "description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [ { "code": "005", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30051.0, "minimum": 30051.14, "maximum": 121550.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 121550.28 } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [ { "code": "812", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5795.0, "minimum": 5795.58, "maximum": 10824.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10824.64 } ] } ] }, { "description": "Alpha-1 Antitrypsin Phenotype", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 289.75, "discounted_cash": 89.0, "minimum": 86.925, "maximum": 262.8032, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 130.39, "10th_percentile": 130.39, "90th_percentile": 130.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.79 } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [ { "code": "651", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11805.0, "minimum": 11805.81, "maximum": 43687.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43687.6 } ] } ] }, { "description": "NM Quadramet Therapy", "code_information": [ { "code": "79101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 597.0, "discounted_cash": 185.0, "minimum": 179.1, "maximum": 541.479, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 275.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 373.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 373.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 454.05 } ] } ] }, { "description": "Genta", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.25, "discounted_cash": 73.0, "minimum": 71.475, "maximum": 216.0927, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.69 } ] } ] }, { "description": "NM Iodine I-123 Ioflupane Up To 5 mCi", "code_information": [ { "code": "A9584", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10167.5, "minimum": 3050.25, "maximum": 10167.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10167.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9452.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10167.5 } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITH CCMCC", "code_information": [ { "code": "600", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 12279.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12279.4 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 18577.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18577.07 } ] } ] }, { "description": "ADAMTS13 Activity", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 606.25, "discounted_cash": 187.0, "minimum": 146.82, "maximum": 549.8687, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 214.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 287.66 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "736", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13093.0, "minimum": 13093.71, "maximum": 42139.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42139.71 } ] } ] }, { "description": "75625 FAC AORTOGRPHY ABD SERIAL S&I", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8687.25, "discounted_cash": 2693.0, "minimum": 507.5982, "maximum": 7879.3358, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 868.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1175.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1175.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 507.6 } ] } ] }, { "description": "XR Arthrogram Knee", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 526.25, "discounted_cash": 163.0, "minimum": 157.875, "maximum": 526.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 369.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 499.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 499.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.25 } ] } ] }, { "description": "ASP INJ INTERMED JT FAC", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.75, "discounted_cash": 109.0, "minimum": 106.425, "maximum": 321.7582, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 354.75, "10th_percentile": 354.75, "90th_percentile": 354.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 108.08, "10th_percentile": 108.08, "90th_percentile": 108.08, "count": "1 through 10" } ] } ] }, { "description": "SSA 60 (Ro) (ENA) Antibody, IgG", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.5, "discounted_cash": 46.0, "minimum": 44.55, "maximum": 148.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 227.8, "10th_percentile": 227.8, "90th_percentile": 433.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 182.78, "10th_percentile": 182.78, "90th_percentile": 182.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 445.5, "10th_percentile": 413.75, "90th_percentile": 594.0, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 53.68, "10th_percentile": 50.64, "90th_percentile": 171.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 269.38, "10th_percentile": 269.38, "90th_percentile": 269.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 89.6, "10th_percentile": 89.6, "90th_percentile": 89.6, "count": "1 through 10" } ] } ] }, { "description": "Bordetella pertussis IgG Ab", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 464.0, "discounted_cash": 143.0, "minimum": 84.34, "maximum": 420.848, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.95 } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "596", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 30514.5819, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 26420.18, "standard_charge_algorithm": "78.53% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 26928.2, "10th_percentile": 26928.2, "90th_percentile": 26928.2, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12761.57 } ] } ] }, { "description": "Follicle Stimulating Hormone", "code_information": [ { "code": "83001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.75, "discounted_cash": 66.0, "minimum": 64.125, "maximum": 193.8713, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 142.14, "10th_percentile": 142.14, "90th_percentile": 142.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 153.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.77, "10th_percentile": 69.77, "90th_percentile": 69.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.91 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 135.95, "10th_percentile": 135.95, "90th_percentile": 135.95, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 171.09, "10th_percentile": 167.86, "90th_percentile": 171.09, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 213.75, "10th_percentile": 213.75, "90th_percentile": 213.75, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 68.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 193.87, "10th_percentile": 193.87, "90th_percentile": 195.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 193.87, "count": "1 through 10" } ] } ] }, { "description": "Mycobacteria ID using 16S DNA Sequencing", "code_information": [ { "code": "87153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 672.75, "discounted_cash": 208.0, "minimum": 201.825, "maximum": 672.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 672.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 672.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 672.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 672.75 } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "905", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 17487.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17487.77 } ] } ] }, { "description": "Echo 2-D Limited F/U w/Contrast - C8924 - 5001003", "code_information": [ { "code": "C8924", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1496.75, "minimum": 449.025, "maximum": 1357.5522, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 637.14, "10th_percentile": 637.14, "90th_percentile": 637.14, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 478.96, "10th_percentile": 478.96, "90th_percentile": 478.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.79, "10th_percentile": 95.79, "90th_percentile": 95.79, "count": "1 through 10" } ] } ] }, { "description": "Glucagon Level", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.5, "discounted_cash": 61.0, "minimum": 59.25, "maximum": 179.1325, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.21 } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CCMCC", "code_information": [ { "code": "487", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7512.0, "minimum": 7512.79, "maximum": 18463.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18463.9 } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (PF) Inj 100 MCG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409909422", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 11.86, "10th_percentile": 11.86, "90th_percentile": 11.86, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 21583.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21583.26 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "661", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3863.0, "minimum": 3863.72, "maximum": 12206.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12206.31 } ] } ] }, { "description": "NEUROLOGICAL EYE DISORDERS", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 9414.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9414.68 } ] } ] }, { "description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "555", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 15582.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15582.67 } ] } ] }, { "description": "IGF Binding Protein-3", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.75, "discounted_cash": 37.0, "minimum": 36.525, "maximum": 121.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.75 } ] } ] }, { "description": "XR Femur Right 1 View", "code_information": [ { "code": "73551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.25, "discounted_cash": 108.0, "minimum": 105.075, "maximum": 317.6768, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.51 } ] } ] }, { "description": "zz.U Microalb - 82043 - 3350129 - 3350129", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.0, "discounted_cash": 39.0, "minimum": 34.22, "maximum": 115.189, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 80.63, "10th_percentile": 80.63, "90th_percentile": 80.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 54.56, "10th_percentile": 54.56, "90th_percentile": 54.56, "count": "36" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.58, "10th_percentile": 39.58, "90th_percentile": 39.58, "count": "36" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 77.12, "10th_percentile": 77.12, "90th_percentile": 77.12, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 97.05, "10th_percentile": 95.22, "90th_percentile": 97.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 98.06, "10th_percentile": 35.28, "90th_percentile": 121.25, "count": "13" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 93.0, "10th_percentile": 80.63, "90th_percentile": 93.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 121.25, "10th_percentile": 121.25, "90th_percentile": 121.25, "count": "67" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "127" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 111.07, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "53" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "25" } ] } ] }, { "description": "96416 CHMO ADMIN IV INFUS 1-8HR - 96416 - 7336416", "code_information": [ { "code": "96416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1267.0, "discounted_cash": 392.0, "minimum": 380.1, "maximum": 1149.169, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 839.26, "10th_percentile": 671.38, "90th_percentile": 839.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1206.75, "10th_percentile": 1206.75, "90th_percentile": 1206.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1149.17, "10th_percentile": 1149.17, "90th_percentile": 1149.17, "count": "1 through 10" } ] } ] }, { "description": "Glucose, 2 Hour Gestational", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.75, "discounted_cash": 51.0, "minimum": 50.025, "maximum": 151.2423, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.97 } ] } ] }, { "description": "Vitamin C Level", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.25, "discounted_cash": 42.0, "minimum": 41.475, "maximum": 125.3928, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 138.25, "10th_percentile": 138.25, "90th_percentile": 138.25, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4722.0, "minimum": 4722.32, "maximum": 10765.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10765.7 } ] } ] }, { "description": "$ PTT Heparin Neutralized", "code_information": [ { "code": "85525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.25, "discounted_cash": 47.0, "minimum": 45.975, "maximum": 138.9977, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.37 } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [ { "code": "194", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 12008.5547, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6010.23, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11457.9, "10th_percentile": 11457.9, "90th_percentile": 11457.9, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6010.23, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11457.9, "10th_percentile": 11457.9, "90th_percentile": 13749.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 6010.23, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2315.0, "10th_percentile": 2315.0, "90th_percentile": 2315.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9500.74 } ] } ] }, { "description": "SIM REP TRK 7.6-12.5 FAC", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 123.0, "minimum": 119.4, "maximum": 360.986, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 312.55, "10th_percentile": 312.55, "90th_percentile": 312.55, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 398.0, "10th_percentile": 398.0, "90th_percentile": 398.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 347.17, "10th_percentile": 347.17, "90th_percentile": 360.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 121.28, "10th_percentile": 121.28, "90th_percentile": 121.28, "count": "1 through 10" } ] } ] }, { "description": "US Obstetrical Transvaginal", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.25, "discounted_cash": 173.0, "minimum": 167.775, "maximum": 507.2398, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 350.79, "10th_percentile": 350.79, "90th_percentile": 350.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 341.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 527.5, "10th_percentile": 527.5, "90th_percentile": 559.25, "count": "12" } ] } ] }, { "description": "Estradiol, Ultrasensitive, LC/MS", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.5, "discounted_cash": 86.0, "minimum": 84.15, "maximum": 261.01, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 230.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 261.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 178.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 280.5, "10th_percentile": 280.5, "90th_percentile": 280.5, "count": "1 through 10" } ] } ] }, { "description": "Fluphenazine Level", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.75, "discounted_cash": 56.0, "minimum": 54.225, "maximum": 163.9402, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.5 } ] } ] }, { "description": "Cytomegalovirus (CMV) Quant. PCR, Plasma", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 613.25, "discounted_cash": 190.0, "minimum": 183.975, "maximum": 556.2178, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 190.11, "10th_percentile": 185.12, "90th_percentile": 196.24, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 185.12, "10th_percentile": 185.12, "90th_percentile": 196.24, "count": "1 through 10" } ] } ] }, { "description": "CT Facial Bones wo Contrast", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1133.75, "discounted_cash": 351.0, "minimum": 340.125, "maximum": 1064.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 434.79, "10th_percentile": 434.79, "90th_percentile": 434.79, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 465.19, "10th_percentile": 255.1, "90th_percentile": 510.19, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 349.08, "10th_percentile": 337.42, "90th_percentile": 370.06, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 890.33, "10th_percentile": 856.03, "90th_percentile": 890.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 772.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 247.68, "10th_percentile": 247.68, "90th_percentile": 330.8, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1095.75, "10th_percentile": 1069.5, "90th_percentile": 1133.75, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 342.24, "10th_percentile": 233.68, "90th_percentile": 362.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 362.8, "10th_percentile": 362.8, "90th_percentile": 993.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 247.68, "10th_percentile": 247.68, "90th_percentile": 330.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 342.24, "10th_percentile": 330.8, "90th_percentile": 350.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 362.8, "10th_percentile": 362.8, "90th_percentile": 362.8, "count": "1 through 10" } ] } ] }, { "description": "MRI Guided Needle Plcmt 77021", "code_information": [ { "code": "77021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000.0, "discounted_cash": 310.0, "minimum": 300.0, "maximum": 1000.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 } ] } ] }, { "description": "Rad Ther Room Level 3", "code_information": [ { "code": "99213", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 63.0, "minimum": 60.975, "maximum": 184.3477, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 63.34, "10th_percentile": 63.34, "90th_percentile": 63.34, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 42.86, "10th_percentile": 42.86, "90th_percentile": 42.86, "count": "229" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 31.09, "10th_percentile": 31.09, "90th_percentile": 37.13, "count": "167" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.25, "10th_percentile": 81.84, "90th_percentile": 101.08, "count": "162" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 60.83, "10th_percentile": 59.71, "90th_percentile": 60.83, "count": "636" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 30.48, "count": "503" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 135.3, "10th_percentile": 30.48, "90th_percentile": 176.35, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.81, "10th_percentile": 30.48, "90th_percentile": 229.71, "count": "315" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.4, "10th_percentile": 30.48, "90th_percentile": 36.4, "count": "45" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 30.48, "count": "57" } ] } ] }, { "description": "88108 AP Bill Non-Gyn Cytology Concentration Technique", "code_information": [ { "code": "88108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.5, "discounted_cash": 62.0, "minimum": 60.15, "maximum": 200.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.5 } ] } ] }, { "description": "XR Nasal Bones 3 Views", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.25, "discounted_cash": 120.0, "minimum": 91.9, "maximum": 353.9567, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 124.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 124.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 368.25, "10th_percentile": 368.25, "90th_percentile": 368.25, "count": "1 through 10" } ] } ] }, { "description": "Erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.0, "discounted_cash": 92.0, "minimum": 89.7, "maximum": 271.193, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 155.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 97.59, "10th_percentile": 97.59, "90th_percentile": 97.59, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 120.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 299.0, "10th_percentile": 299.0, "90th_percentile": 299.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.68, "10th_percentile": 95.68, "90th_percentile": 95.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 95.68, "10th_percentile": 95.68, "90th_percentile": 95.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.68, "10th_percentile": 95.68, "90th_percentile": 95.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 95.68, "10th_percentile": 95.68, "90th_percentile": 95.68, "count": "1 through 10" } ] } ] }, { "description": "Developmental Testing Ea Add 30 Min OT", "code_information": [ { "code": "96113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.25, "discounted_cash": 71.0, "minimum": 69.675, "maximum": 210.6507, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CT Entire Lower Extrem RT WO Contrast", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.0, "discounted_cash": 537.0, "minimum": 520.5, "maximum": 1573.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1111.27, "10th_percentile": 1111.27, "90th_percentile": 1266.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 780.75, "10th_percentile": 646.09, "90th_percentile": 780.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 496.78, "10th_percentile": 468.63, "90th_percentile": 566.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1064.73 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 727.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 487.04, "10th_percentile": 487.04, "90th_percentile": 523.76, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1435.75, "10th_percentile": 1435.75, "90th_percentile": 1522.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 487.04, "10th_percentile": 459.44, "90th_percentile": 974.16, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 717.89, "10th_percentile": 717.89, "90th_percentile": 717.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 555.2, "10th_percentile": 459.44, "90th_percentile": 974.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 459.44, "10th_percentile": 459.44, "90th_percentile": 487.04, "count": "1 through 10" } ] } ] }, { "description": "SLP Pharyngeal Swallow Eval Units", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.0, "discounted_cash": 153.0, "minimum": 95.0, "maximum": 449.872, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 158.72, "10th_percentile": 158.72, "90th_percentile": 158.72, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659.0, "minimum": 9659.3, "maximum": 17409.97, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17409.97 } ] } ] }, { "description": "XR Humerus Left", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.75, "discounted_cash": 128.0, "minimum": 81.71, "maximum": 375.2713, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 259.52, "10th_percentile": 259.52, "90th_percentile": 259.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 186.19, "10th_percentile": 186.19, "90th_percentile": 186.19, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 413.75, "10th_percentile": 413.75, "90th_percentile": 413.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 132.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 132.4, "10th_percentile": 24.98, "90th_percentile": 132.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 124.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 132.4, "count": "1 through 10" } ] } ] }, { "description": "XR Chest 3 Views 71047", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.25, "discounted_cash": 79.0, "minimum": 76.575, "maximum": 248.1986, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 216.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.2 } ] } ] }, { "description": "NM Tumor Imaging Multiple", "code_information": [ { "code": "78801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1782.75, "discounted_cash": 552.0, "minimum": 534.825, "maximum": 1782.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 812.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1100.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1100.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1782.75 } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [ { "code": "350", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 29376.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29376.96 } ] } ] }, { "description": "IL28B rs12979860", "code_information": [ { "code": "81400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 606.25, "discounted_cash": 187.0, "minimum": 181.875, "maximum": 596.2095, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 293.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 200.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 596.21 } ] } ] }, { "description": "SO KRAS Mutation Detection", "code_information": [ { "code": "88381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 566.0, "discounted_cash": 175.0, "minimum": 169.8, "maximum": 566.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 566.0 } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [ { "code": "480", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13093.0, "minimum": 13093.71, "maximum": 34333.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34333.05 } ] } ] }, { "description": "Venous Draw", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "discounted_cash": 9.0, "minimum": 9.6, "maximum": 29.024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 21.28, "count": "51" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.44, "10th_percentile": 10.44, "90th_percentile": 10.44, "count": "349" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 20.35, "10th_percentile": 13.12, "90th_percentile": 20.35, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "297" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 21.28, "10th_percentile": 6.19, "90th_percentile": 24.77, "count": "19" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "1073" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.24, "count": "1518" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 29.02, "10th_percentile": 10.24, "90th_percentile": 29.31, "count": "185" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 139.53, "count": "998" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.24, "count": "145" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.24, "count": "125" } ] } ] }, { "description": "PCA3 (Prostate Cancer Biomarker)", "code_information": [ { "code": "81313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1278.25, "discounted_cash": 396.0, "minimum": 383.475, "maximum": 1278.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1278.25 } ] } ] }, { "description": "93246 F EXT ECG>7D<15D RECORDING", "code_information": [ { "code": "93246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.25, "discounted_cash": 19.0, "minimum": 18.975, "maximum": 57.3678, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 48.51, "10th_percentile": 48.51, "90th_percentile": 48.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 41.9, "10th_percentile": 41.9, "90th_percentile": 41.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.67, "10th_percentile": 19.67, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 50.46, "10th_percentile": 50.46, "90th_percentile": 50.46, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 63.25, "10th_percentile": 63.25, "90th_percentile": 63.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.24, "10th_percentile": 20.24, "90th_percentile": 20.24, "count": "1 through 10" } ] } ] }, { "description": "Bill IRL Cold Agg Screen", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.5, "discounted_cash": 48.0, "minimum": 40.79, "maximum": 141.0385, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.23 } ] } ] }, { "description": "CT Head Code Stroke", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1560.25, "discounted_cash": 483.0, "minimum": 468.075, "maximum": 1415.1468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 585.63, "10th_percentile": 580.33, "90th_percentile": 1196.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 642.38, "10th_percentile": 321.19, "90th_percentile": 680.96, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 958.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 480.46, "10th_percentile": 465.94, "90th_percentile": 493.92, "count": "41" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 958.04 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1188.36, "10th_percentile": 1142.57, "90th_percentile": 1188.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 583.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 456.8, "10th_percentile": 99.3, "90th_percentile": 1427.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1160.66, "10th_percentile": 1160.66, "90th_percentile": 1160.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1513.25, "10th_percentile": 1427.5, "90th_percentile": 1513.25, "count": "73" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 484.24, "10th_percentile": 456.8, "90th_percentile": 484.24, "count": "119" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1138.86, "10th_percentile": 484.24, "90th_percentile": 1307.59, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 484.24, "10th_percentile": 456.8, "90th_percentile": 484.24, "count": "82" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 484.24, "10th_percentile": 484.24, "90th_percentile": 484.24, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 456.8, "10th_percentile": 456.8, "90th_percentile": 484.24, "count": "12" } ] } ] }, { "description": "C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 329.5, "discounted_cash": 102.0, "minimum": 98.85, "maximum": 298.8565, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 148.28, "10th_percentile": 148.28, "90th_percentile": 148.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 194.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 329.5, "10th_percentile": 329.5, "90th_percentile": 329.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.44, "10th_percentile": 105.44, "90th_percentile": 105.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 105.44, "10th_percentile": 105.44, "90th_percentile": 105.44, "count": "1 through 10" } ] } ] }, { "description": "Coccidioides Ab by CF", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.25, "discounted_cash": 20.0, "minimum": 19.575, "maximum": 65.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 65.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.25 } ] } ] }, { "description": "FINGER SPLINT FAC", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 464.0, "discounted_cash": 143.0, "minimum": 139.2, "maximum": 420.848, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 464.0, "10th_percentile": 464.0, "90th_percentile": 464.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 141.44, "10th_percentile": 141.44, "90th_percentile": 141.44, "count": "1 through 10" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [ { "code": "086", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 15357.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15357.5 } ] } ] }, { "description": "ALT (Alanine Aminotransferase)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 22.0, "minimum": 21.6, "maximum": 65.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 57.36, "10th_percentile": 57.36, "90th_percentile": 57.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 38.81, "10th_percentile": 38.81, "90th_percentile": 38.81, "count": "42" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.15, "10th_percentile": 28.15, "90th_percentile": 28.15, "count": "37" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 54.86, "10th_percentile": 54.86, "90th_percentile": 54.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 67.73, "10th_percentile": 67.73, "90th_percentile": 69.03, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 86.25, "10th_percentile": 75.44, "90th_percentile": 86.25, "count": "41" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 16.67, "10th_percentile": 16.67, "90th_percentile": 66.15, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 86.25, "10th_percentile": 86.25, "90th_percentile": 86.25, "count": "86" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 27.6, "count": "200" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 68.81, "10th_percentile": 27.6, "90th_percentile": 79.01, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 27.6, "count": "87" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 27.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 27.6, "count": "24" } ] } ] }, { "description": "MRI Axilla Left w+wo 71552", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "discounted_cash": 930.0, "minimum": 900.0, "maximum": 3000.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2949.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2949.2 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3000.75 } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "494", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 23654.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23654.59 } ] } ] }, { "description": "IR Hepatic Venogram w PRES 75889", "code_information": [ { "code": "75889", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7514.0, "discounted_cash": 2329.0, "minimum": 611.959, "maximum": 6815.198, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 844.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1143.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1143.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 611.96 } ] } ] }, { "description": "XR Ankle Left 3 Views", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 386.75, "discounted_cash": 119.0, "minimum": 87.53, "maximum": 350.7822, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 242.56, "10th_percentile": 242.56, "90th_percentile": 242.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 164.14, "10th_percentile": 164.14, "90th_percentile": 174.04, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.05, "10th_percentile": 119.05, "90th_percentile": 126.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 245.97, "10th_percentile": 231.98, "90th_percentile": 309.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 291.95, "10th_percentile": 291.95, "90th_percentile": 291.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.76, "10th_percentile": 116.72, "90th_percentile": 162.92, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 296.64, "10th_percentile": 296.64, "90th_percentile": 296.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 386.75, "10th_percentile": 364.75, "90th_percentile": 386.75, "count": "65" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 116.72, "10th_percentile": 116.72, "90th_percentile": 123.76, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 334.11, "10th_percentile": 116.72, "90th_percentile": 350.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.76, "10th_percentile": 15.0, "90th_percentile": 123.76, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 116.72, "10th_percentile": 116.72, "90th_percentile": 123.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 123.76, "10th_percentile": 123.76, "90th_percentile": 123.76, "count": "1 through 10" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6439.0, "minimum": 6439.53, "maximum": 45908.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45908.65 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10517.0, "minimum": 4796.1916, "maximum": 19405.84, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19405.84 } ] } ] }, { "description": "88363 Retrieval of Archived Specimens", "code_information": [ { "code": "88363", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.5, "discounted_cash": 37.0, "minimum": 36.45, "maximum": 121.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.5 } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [ { "code": "300", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 15181.5262, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6654.18, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17052.4, "10th_percentile": 17052.4, "90th_percentile": 19183.95, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12584.74 } ] } ] }, { "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": 5580.0, "minimum": 5580.93, "maximum": 12338.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12338.35 } ] } ] }, { "description": ".Cryoglobulin reflex", "code_information": [ { "code": "86329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 29.0, "minimum": 28.2, "maximum": 94.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 89.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.0 } ] } ] }, { "description": "SPLENIC PROCEDURES WITH CC", "code_information": [ { "code": "800", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 33119.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33119.96 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22323.0, "minimum": 22323.7, "maximum": 99379.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 99379.92 } ] } ] }, { "description": "Occult Blood FIT, Stool", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.0, "discounted_cash": 28.0, "minimum": 27.9, "maximum": 93.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 61.85, "10th_percentile": 61.85, "90th_percentile": 61.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 41.85, "10th_percentile": 41.85, "90th_percentile": 41.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 30.36, "10th_percentile": 30.36, "90th_percentile": 30.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 89.21 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 73.03, "10th_percentile": 73.03, "90th_percentile": 73.03, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 93.0, "10th_percentile": 93.0, "90th_percentile": 93.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 29.76, "10th_percentile": 15.92, "90th_percentile": 29.76, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 85.19, "10th_percentile": 85.19, "90th_percentile": 85.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 29.76, "10th_percentile": 10.0, "90th_percentile": 29.76, "count": "1 through 10" } ] } ] }, { "description": "XR Enema Barium Double Contrast", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1280.5, "discounted_cash": 396.0, "minimum": 384.15, "maximum": 1280.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 577.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 782.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 782.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1280.5 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156.0, "minimum": 8156.74, "maximum": 18263.2386, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14951.96 } ] } ] }, { "description": "ROOM/BED: Observation", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.5, "minimum": 28.05, "maximum": 84.8045, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 883.58, "10th_percentile": 612.0, "90th_percentile": 1051.88, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 860.06, "10th_percentile": 366.22, "90th_percentile": 1831.1, "count": "14" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 440.55, "10th_percentile": 204.1, "90th_percentile": 816.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 74.59, "10th_percentile": 74.59, "90th_percentile": 74.59, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 561.0, "10th_percentile": 170.0, "90th_percentile": 1785.0, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 359.04, "10th_percentile": 217.6, "90th_percentile": 1958.4, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 254.41, "10th_percentile": 254.41, "90th_percentile": 2034.39, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 388.96, "10th_percentile": 388.96, "90th_percentile": 489.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 380.8, "10th_percentile": 29.92, "90th_percentile": 688.16, "count": "13" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 119.68, "10th_percentile": 54.4, "90th_percentile": 544.0, "count": "1 through 10" } ] } ] }, { "description": "I-D ABSCESS SIMPLE FAC", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 173.0, "minimum": 167.625, "maximum": 506.7862, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 411.96, "10th_percentile": 411.96, "90th_percentile": 432.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 173.73, "10th_percentile": 173.73, "90th_percentile": 173.73, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 558.75, "10th_percentile": 532.25, "90th_percentile": 558.75, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 178.8, "10th_percentile": 170.32, "90th_percentile": 178.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 445.77, "10th_percentile": 445.77, "90th_percentile": 445.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 178.8, "10th_percentile": 178.8, "90th_percentile": 178.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.32, "10th_percentile": 170.32, "90th_percentile": 178.8, "count": "1 through 10" } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [ { "code": "019", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21679.0, "minimum": 21679.75, "maximum": 84109.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84109.66 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 12664.41, "maximum": 65110.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65110.54 } ] } ] }, { "description": "REHABILITATION WITH CCMCC", "code_information": [ { "code": "945", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12020.0, "minimum": 12020.46, "maximum": 18256.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18256.41 } ] } ] }, { "description": "MRI Cervical Spine wo Contrast", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1925.5, "discounted_cash": 596.0, "minimum": 577.65, "maximum": 1906.22, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 866.48, "10th_percentile": 866.48, "90th_percentile": 866.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 628.48, "10th_percentile": 628.48, "90th_percentile": 628.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1512.1, "10th_percentile": 1512.1, "90th_percentile": 1512.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1071.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1925.5, "10th_percentile": 1925.5, "90th_percentile": 1925.5, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC", "code_information": [ { "code": "496", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 21266.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21266.14 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2361.0, "minimum": 2361.16, "maximum": 7060.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7060.42 } ] } ] }, { "description": ".Endomysial Ab, IgA w/Reflex", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 45.0, "minimum": 43.95, "maximum": 132.8755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 113.39, "10th_percentile": 113.39, "90th_percentile": 117.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 68.96, "10th_percentile": 68.96, "90th_percentile": 141.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 47.82, "10th_percentile": 47.82, "90th_percentile": 47.82, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 93.17, "10th_percentile": 47.7, "90th_percentile": 197.64, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 122.66, "10th_percentile": 117.26, "90th_percentile": 252.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 141.57, "10th_percentile": 141.57, "90th_percentile": 141.57, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 97.42, "10th_percentile": 97.42, "90th_percentile": 117.54, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 153.25, "10th_percentile": 146.5, "90th_percentile": 310.75, "count": "39" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.2, "10th_percentile": 16.0, "90th_percentile": 100.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 139.0, "10th_percentile": 132.88, "90th_percentile": 285.71, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 100.8, "10th_percentile": 46.88, "90th_percentile": 140.38, "count": "1 through 10" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9873.0, "minimum": 9873.95, "maximum": 24156.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24156.8 } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8371.0, "minimum": 8371.39, "maximum": 30292.7043, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8748.09, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7313.86, "10th_percentile": 7313.86, "90th_percentile": 7313.86, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8371.39, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11457.9, "10th_percentile": 11457.9, "90th_percentile": 14920.85, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16937.23 } ] } ] }, { "description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [ { "code": "882", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 12659.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12659.01 } ] } ] }, { "description": "Echo Doppler Color Flow", "code_information": [ { "code": "93325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.5, "discounted_cash": 165.0, "minimum": 159.75, "maximum": 482.9775, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 352.73, "10th_percentile": 352.73, "90th_percentile": 352.73, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 532.5, "10th_percentile": 532.5, "90th_percentile": 532.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.4, "10th_percentile": 170.4, "90th_percentile": 340.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 50.0, "10th_percentile": 34.08, "90th_percentile": 929.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 170.4, "10th_percentile": 170.4, "90th_percentile": 170.4, "count": "1 through 10" } ] } ] }, { "description": "HYPERTENSION WITH MCC", "code_information": [ { "code": "304", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 14028.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14028.89 } ] } ] }, { "description": "Vitamin B12 Binding Capacity", "code_information": [ { "code": "82608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 53.0, "minimum": 51.9, "maximum": 156.911, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.49 } ] } ] }, { "description": "Schistosoma IgG Antibody", "code_information": [ { "code": "86682", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.0, "discounted_cash": 37.0, "minimum": 36.6, "maximum": 121.274, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.04, "10th_percentile": 39.04, "90th_percentile": 39.04, "count": "1 through 10" } ] } ] }, { "description": "ST Fat Qnt", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.5, "discounted_cash": 59.0, "minimum": 58.05, "maximum": 175.5045, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.6 } ] } ] }, { "description": "SLP Eval Lang Comprehension,Express Unit", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 722.75, "discounted_cash": 224.0, "minimum": 95.0, "maximum": 655.5343, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "072", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 8914.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8914.83 } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [ { "code": "184", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 12544.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12544.65 } ] } ] }, { "description": "88305 AP Bill Surgical Pathology Level IV Complexity", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 369.75, "discounted_cash": 114.0, "minimum": 110.925, "maximum": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 245.88, "10th_percentile": 245.88, "90th_percentile": 245.88, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 166.39, "10th_percentile": 166.39, "90th_percentile": 499.16, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 251.32, "10th_percentile": 201.07, "90th_percentile": 502.64, "count": "78" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.69, "10th_percentile": 120.69, "90th_percentile": 362.06, "count": "30" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 235.16, "10th_percentile": 235.16, "90th_percentile": 235.16, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 295.95, "10th_percentile": 290.36, "90th_percentile": 580.73, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 369.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 190.59, "10th_percentile": 190.59, "90th_percentile": 190.59, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 283.6, "10th_percentile": 79.39, "90th_percentile": 572.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 369.75, "10th_percentile": 369.75, "90th_percentile": 739.5, "count": "64" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.32, "10th_percentile": 118.32, "90th_percentile": 236.64, "count": "90" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 338.69, "10th_percentile": 335.36, "90th_percentile": 677.38, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 2703.09, "10th_percentile": 220.84, "90th_percentile": 4508.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.32, "10th_percentile": 118.32, "90th_percentile": 473.28, "count": "26" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 118.32, "10th_percentile": 118.32, "90th_percentile": 236.64, "count": "1 through 10" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "084", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 11267.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11267.91 } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7512.0, "minimum": 7512.79, "maximum": 19824.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19824.35 } ] } ] }, { "description": "DNA (ds) AB, Crithidia IFAA w/ Reflx", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.0, "discounted_cash": 44.0, "minimum": 43.2, "maximum": 130.608, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 111.46, "10th_percentile": 111.46, "90th_percentile": 111.46, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 47.0, "10th_percentile": 47.0, "90th_percentile": 47.0, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 152.75, "10th_percentile": 144.0, "90th_percentile": 152.75, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 46.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 138.54, "10th_percentile": 138.54, "90th_percentile": 138.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 46.08, "count": "1 through 10" } ] } ] }, { "description": "Quantiferon TB Gold, 1 Tube", "code_information": [ { "code": "86480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.25, "discounted_cash": 98.0, "minimum": 95.775, "maximum": 319.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 233.17, "10th_percentile": 233.17, "90th_percentile": 247.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 135.56, "10th_percentile": 135.56, "90th_percentile": 143.66, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 98.33, "10th_percentile": 98.33, "90th_percentile": 104.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 319.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 203.04, "10th_percentile": 203.04, "90th_percentile": 203.04, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 241.12, "10th_percentile": 241.12, "90th_percentile": 250.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 319.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 301.25, "10th_percentile": 301.25, "90th_percentile": 319.25, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 96.4, "10th_percentile": 96.4, "90th_percentile": 102.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 289.56, "10th_percentile": 102.16, "90th_percentile": 292.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 102.16, "10th_percentile": 96.4, "90th_percentile": 102.16, "count": "1 through 10" } ] } ] }, { "description": "Methylenetetrahydrofolate Mutation", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.75, "discounted_cash": 127.0, "minimum": 123.225, "maximum": 410.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 295.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 202.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 410.75 } ] } ] }, { "description": "Osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.75, "discounted_cash": 27.0, "minimum": 26.625, "maximum": 80.4963, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.28 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 56.45, "10th_percentile": 56.45, "90th_percentile": 56.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 88.75, "10th_percentile": 88.75, "90th_percentile": 88.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 88.75, "10th_percentile": 88.75, "90th_percentile": 88.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" } ] } ] }, { "description": "CA 27.29", "code_information": [ { "code": "86300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 38.0, "minimum": 37.125, "maximum": 123.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.36, "10th_percentile": 37.36, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 39.6, "10th_percentile": 37.36, "90th_percentile": 39.6, "count": "1 through 10" } ] } ] }, { "description": "XR Acute Abdomen w PA Chest", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 771.0, "discounted_cash": 239.0, "minimum": 128.39, "maximum": 699.297, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 128.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 173.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 727.25, "10th_percentile": 727.25, "90th_percentile": 727.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 232.72, "10th_percentile": 232.72, "90th_percentile": 246.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 580.2, "10th_percentile": 580.2, "90th_percentile": 580.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 232.72, "10th_percentile": 232.72, "90th_percentile": 232.72, "count": "1 through 10" } ] } ] }, { "description": "75831 FAC VEIN X-RAY KIDNEY", "code_information": [ { "code": "75831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8686.0, "discounted_cash": 2692.0, "minimum": 580.9513, "maximum": 7878.202, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 843.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1141.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1141.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 580.95 } ] } ] }, { "description": "NM Lymphoseek Up To 0.5MCI", "code_information": [ { "code": "A9520", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2047.5, "minimum": 614.25, "maximum": 2047.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2047.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2047.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2047.5 } ] } ] }, { "description": "75710 FAC LE ANGIO IMAGING UNILAT", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8207.75, "discounted_cash": 2544.0, "minimum": 583.7516, "maximum": 7444.4293, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 929.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1258.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1258.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 583.75 } ] } ] }, { "description": "LD (Lactate Dehydrogenase)", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 31.0, "minimum": 30.6, "maximum": 92.514, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 102.0, "10th_percentile": 1.48, "90th_percentile": 102.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 92.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "27" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 45.9, "10th_percentile": 45.9, "90th_percentile": 45.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 33.29, "10th_percentile": 33.29, "90th_percentile": 33.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.6 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 64.87, "10th_percentile": 64.87, "90th_percentile": 129.74, "count": "1 through 10" } ] } ] }, { "description": "CT Ankle Left w Contrast", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.0, "discounted_cash": 537.0, "minimum": 520.5, "maximum": 1573.645, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1459.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1459.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 987.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1735.0, "10th_percentile": 1735.0, "90th_percentile": 1735.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 453.92, "10th_percentile": 453.92, "90th_percentile": 523.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 555.2, "10th_percentile": 555.2, "90th_percentile": 555.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 487.04, "10th_percentile": 487.04, "90th_percentile": 487.04, "count": "1 through 10" } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC", "code_information": [ { "code": "457", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 70298.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70298.87 } ] } ] }, { "description": "Smooth Muscle Ab, IgG Titer", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.75, "discounted_cash": 66.0, "minimum": 64.725, "maximum": 195.6852, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 203.5, "10th_percentile": 203.5, "90th_percentile": 203.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 69.04, "10th_percentile": 69.04, "90th_percentile": 69.04, "count": "1 through 10" } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "670", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 11521.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11521.37 } ] } ] }, { "description": "Vaginal Screen, Gard. vaginalis", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.5, "discounted_cash": 20.0, "minimum": 19.65, "maximum": 65.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 41.06, "10th_percentile": 41.06, "90th_percentile": 50.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.79, "10th_percentile": 27.79, "90th_percentile": 29.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.16, "10th_percentile": 20.16, "90th_percentile": 20.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 41.66, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 51.44, "10th_percentile": 49.42, "90th_percentile": 51.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1.57, "10th_percentile": 1.57, "90th_percentile": 62.06, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 50.24, "10th_percentile": 50.24, "90th_percentile": 50.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 65.5, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "63" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.05, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 56.56, "10th_percentile": 49.26, "90th_percentile": 59.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 19.76, "10th_percentile": 19.76, "90th_percentile": 19.76, "count": "1 through 10" } ] } ] }, { "description": "Hepatitis B Core Antibody, Total", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.25, "discounted_cash": 35.0, "minimum": 34.575, "maximum": 112.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 72.32, "10th_percentile": 72.32, "90th_percentile": 72.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 48.94, "10th_percentile": 48.94, "90th_percentile": 48.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 73.3, "10th_percentile": 73.3, "90th_percentile": 73.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 87.04, "10th_percentile": 87.04, "90th_percentile": 87.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 115.25, "10th_percentile": 108.75, "90th_percentile": 115.25, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.61, "10th_percentile": 34.8, "90th_percentile": 104.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.88, "10th_percentile": 34.8, "90th_percentile": 36.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 36.88, "count": "1 through 10" } ] } ] }, { "description": "Troponin", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.5, "discounted_cash": 61.0, "minimum": 59.55, "maximum": 180.0395, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 132.0, "10th_percentile": 132.0, "90th_percentile": 132.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 89.33, "10th_percentile": 89.33, "90th_percentile": 178.65, "count": "48" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 64.79, "10th_percentile": 64.79, "90th_percentile": 129.58, "count": "50" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.96 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 162.77, "10th_percentile": 162.57, "90th_percentile": 317.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 158.88, "10th_percentile": 155.88, "90th_percentile": 317.76, "count": "17" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 198.5, "10th_percentile": 57.22, "90th_percentile": 198.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 38.37, "10th_percentile": 38.37, "90th_percentile": 153.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 198.5, "10th_percentile": 198.5, "90th_percentile": 397.0, "count": "211" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "150" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 360.08, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "111" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "46" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "14" } ] } ] }, { "description": "Von Willebrand Factor Activity", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.5, "discounted_cash": 97.0, "minimum": 94.05, "maximum": 284.3445, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 214.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.84 } ] } ] }, { "description": "Eosinophils Smear, Other", "code_information": [ { "code": "89190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.5, "discounted_cash": 30.0, "minimum": 29.25, "maximum": 88.4325, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.97 } ] } ] }, { "description": "NM Lymphoscinitigraphy", "code_information": [ { "code": "78195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1184.5, "discounted_cash": 367.0, "minimum": 355.35, "maximum": 1184.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1062.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1184.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1184.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1184.5 } ] } ] }, { "description": "O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [ { "code": "876", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15669.0, "minimum": 15669.52, "maximum": 45563.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45563.23 } ] } ] }, { "description": "MRI Gadolinium per ml", "code_information": [ { "code": "A9579", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.5, "minimum": 3.75, "maximum": 12.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 191.75, "10th_percentile": 95.88, "90th_percentile": 191.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 84.38, "10th_percentile": 56.25, "90th_percentile": 112.5, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 81.6, "10th_percentile": 61.2, "90th_percentile": 81.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 147.24, "10th_percentile": 147.24, "90th_percentile": 196.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 235.0, "10th_percentile": 176.25, "90th_percentile": 250.0, "count": "33" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.0, "10th_percentile": 37.6, "90th_percentile": 80.0, "count": "44" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 199.45, "10th_percentile": 107.63, "90th_percentile": 226.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 56.4, "10th_percentile": 37.6, "90th_percentile": 80.0, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 60.0, "10th_percentile": 56.4, "90th_percentile": 80.0, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 80.0, "10th_percentile": 56.4, "90th_percentile": 80.0, "count": "1 through 10" } ] } ] }, { "description": "MRI Abdomen wo Contrast", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1549.25, "discounted_cash": 480.0, "minimum": 464.775, "maximum": 1549.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1549.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 505.68, "10th_percentile": 505.68, "90th_percentile": 505.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1549.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1125.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1549.25, "10th_percentile": 1549.25, "90th_percentile": 1549.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 480.27, "10th_percentile": 480.27, "90th_percentile": 495.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 495.76, "10th_percentile": 495.76, "90th_percentile": 495.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 495.76, "10th_percentile": 495.76, "90th_percentile": 495.76, "count": "1 through 10" } ] } ] }, { "description": "US Preg Uterus Single", "code_information": [ { "code": "76811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 931.5, "discounted_cash": 288.0, "minimum": 279.45, "maximum": 844.8705, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 622.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 622.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 747.33 } ] } ] }, { "description": "5HIAA, Urine Random", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.25, "discounted_cash": 45.0, "minimum": 44.175, "maximum": 133.5557, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 66.26, "10th_percentile": 66.26, "90th_percentile": 66.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 12.9, "10th_percentile": 12.9, "90th_percentile": 12.9, "count": "1 through 10" } ] } ] }, { "description": "$ AP 88312 Dahl-Chase - 88312 - 3302007 - 3302007", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 355.75, "discounted_cash": 110.0, "minimum": 106.725, "maximum": 355.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 58.95, "10th_percentile": 58.95, "90th_percentile": 58.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 71.24, "10th_percentile": 71.24, "90th_percentile": 178.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 355.75 } ] } ] }, { "description": "Drug Monitoring, Phosphatatidylethanol (Peth), Blood - 80321 - 3351254", "code_information": [ { "code": "80321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 382.5, "discounted_cash": 118.0, "minimum": 114.75, "maximum": 346.9275, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 253.37, "10th_percentile": 253.37, "90th_percentile": 253.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 122.4, "10th_percentile": 118.58, "90th_percentile": 122.4, "count": "1 through 10" } ] } ] }, { "description": "MA Breast Add Views Tomo BCHP Bilat 77062", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 637.5, "discounted_cash": 197.0, "minimum": 191.25, "maximum": 637.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 488.96, "10th_percentile": 488.96, "90th_percentile": 488.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 286.88, "10th_percentile": 286.88, "90th_percentile": 286.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 383.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 519.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 519.55 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 500.63, "10th_percentile": 500.63, "90th_percentile": 500.63, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 637.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 64.35, "10th_percentile": 64.35, "90th_percentile": 64.35, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 204.0, "10th_percentile": 204.0, "90th_percentile": 204.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 204.0, "10th_percentile": 204.0, "90th_percentile": 204.0, "count": "1 through 10" } ] } ] }, { "description": "XR Foot Left AP and Lateral", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.25, "discounted_cash": 85.0, "minimum": 71.47, "maximum": 248.7448, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 164.57, "10th_percentile": 164.57, "90th_percentile": 164.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 258.75, "10th_percentile": 258.75, "90th_percentile": 274.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 87.76, "count": "1 through 10" } ] } ] }, { "description": "ED ECHO EXAM OF ABDOMEN FAC", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 537.5, "discounted_cash": 166.0, "minimum": 161.25, "maximum": 504.7979, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 511.88, "10th_percentile": 511.88, "90th_percentile": 511.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 399.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 399.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 504.8 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 625.87, "10th_percentile": 595.79, "90th_percentile": 625.87, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 733.0, "10th_percentile": 733.0, "90th_percentile": 733.0, "count": "1 through 10" } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC", "code_information": [ { "code": "493", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9015.0, "minimum": 9015.34, "maximum": 48525.9421, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29898.03 } ] } ] }, { "description": "Vasoactive Intestinal Peptide (VIP)", "code_information": [ { "code": "84586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 539.5, "discounted_cash": 167.0, "minimum": 122.16, "maximum": 489.3265, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 157.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 178.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 122.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 329.33 } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITH CC", "code_information": [ { "code": "386", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7083.0, "minimum": 7083.48, "maximum": 11509.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11509.58 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CCMCC", "code_information": [ { "code": "498", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 9444.64, "maximum": 35564.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35564.99 } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [ { "code": "548", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12664.0, "minimum": 12664.41, "maximum": 22763.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22763.34 } ] } ] }, { "description": "Chromosome Analysis Prod. of Conception", "code_information": [ { "code": "88262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 772.25, "discounted_cash": 239.0, "minimum": 231.675, "maximum": 772.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 772.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 772.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 772.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 772.25 } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 16700.4277, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 4078.37, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13749.48, "10th_percentile": 13749.48, "90th_percentile": 13749.48, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8860.6 } ] } ] }, { "description": "Babesia microti Antibody, IgG by IFA", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.75, "discounted_cash": 34.0, "minimum": 33.825, "maximum": 112.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.75 } ] } ] }, { "description": ".ADAMTS13 Inhibitor", "code_information": [ { "code": "85335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.0, "discounted_cash": 149.0, "minimum": 82.37, "maximum": 436.267, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.97 } ] } ] }, { "description": "HC (SUP SHELL C1713) ANCHR/SCREW OPPOS BN-BN/SFT TISS-BN", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 2305.13, "10th_percentile": 675.11, "90th_percentile": 3236.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 1056.47, "10th_percentile": 240.36, "90th_percentile": 9189.88, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 1591.11, "10th_percentile": 1591.11, "90th_percentile": 1591.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 23948.76, "10th_percentile": 23948.76, "90th_percentile": 23948.76, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 4316.75, "10th_percentile": 4316.75, "90th_percentile": 8254.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 606.48, "10th_percentile": 606.48, "90th_percentile": 755.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 62.17, "10th_percentile": 62.17, "90th_percentile": 99.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 270.72, "10th_percentile": 270.72, "90th_percentile": 2263.92, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9229.0, "minimum": 9229.99, "maximum": 19698.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19698.21 } ] } ] }, { "description": "Vaginal Screen, Trichomonas", "code_information": [ { "code": "87660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.5, "discounted_cash": 20.0, "minimum": 19.65, "maximum": 65.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 41.06, "10th_percentile": 41.06, "90th_percentile": 50.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 27.79, "10th_percentile": 27.79, "90th_percentile": 29.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.16, "10th_percentile": 20.16, "90th_percentile": 20.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 55.58, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 51.44, "10th_percentile": 49.42, "90th_percentile": 51.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 61.75, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 50.24, "10th_percentile": 50.24, "90th_percentile": 50.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 65.5, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "63" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 20.05, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 56.57, "10th_percentile": 49.26, "90th_percentile": 638.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 268.73, "10th_percentile": 19.76, "90th_percentile": 347.69, "count": "1 through 10" } ] } ] }, { "description": "NM Y90 Mapping 78201", "code_information": [ { "code": "78201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1364.0, "discounted_cash": 422.0, "minimum": 409.2, "maximum": 1328.279, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 596.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 807.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 807.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1328.28 } ] } ] }, { "description": "Hemochromatosis Mutation-PCR", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.75, "discounted_cash": 104.0, "minimum": 100.725, "maximum": 335.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 245.16, "10th_percentile": 245.16, "90th_percentile": 245.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 335.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.75 } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "470", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 22739.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22739.76 } ] } ] }, { "description": "Cmv antibody", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.0, "discounted_cash": 56.0, "minimum": 54.3, "maximum": 164.167, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 151.0, "10th_percentile": 151.0, "90th_percentile": 151.0, "count": "1 through 10" } ] } ] }, { "description": "Creatine Kinase MB", "code_information": [ { "code": "82553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.25, "discounted_cash": 65.0, "minimum": 49.6, "maximum": 190.6968, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.66 } ] } ] }, { "description": "XR Hand Left 3 Views", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.75, "discounted_cash": 127.0, "minimum": 87.53, "maximum": 372.5503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 315.05, "10th_percentile": 299.93, "90th_percentile": 317.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 184.84, "10th_percentile": 174.38, "90th_percentile": 184.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 126.48, "10th_percentile": 124.0, "90th_percentile": 134.07, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 317.36, "10th_percentile": 261.24, "90th_percentile": 336.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 310.16, "10th_percentile": 310.16, "90th_percentile": 322.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 367.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 410.75, "10th_percentile": 387.5, "90th_percentile": 410.75, "count": "46" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 131.44, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 213.28, "10th_percentile": 131.44, "90th_percentile": 745.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 131.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 131.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 124.0, "10th_percentile": 124.0, "90th_percentile": 131.44, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [ { "code": "650", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13523.0, "minimum": 13523.01, "maximum": 55424.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55424.71 } ] } ] }, { "description": "XR Sm Int F-Thru Std 74248", "code_information": [ { "code": "74248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.75, "discounted_cash": 292.0, "minimum": 283.125, "maximum": 855.9813, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.18 } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "468", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 32396.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32396.12 } ] } ] }, { "description": "US Obstetrical Multi 14+ Wk", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 881.5, "discounted_cash": 273.0, "minimum": 264.45, "maximum": 799.5205, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 290.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 290.39 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 349.69 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4293.0, "minimum": 4293.02, "maximum": 7301.3409, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7272.62 } ] } ] }, { "description": "MRI Cervical Spine w Contrast", "code_information": [ { "code": "72142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2230.0, "discounted_cash": 691.0, "minimum": 669.0, "maximum": 2230.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2230.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2230.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2230.0, "10th_percentile": 2230.0, "90th_percentile": 2230.0, "count": "1 through 10" } ] } ] }, { "description": "REMOVAL SUTR OR STAPL XREQ ANES FAC", "code_information": [ { "code": "15853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.0, "discounted_cash": 37.0, "minimum": 36.6, "maximum": 110.654, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "1 through 10" } ] } ] }, { "description": "MRI Axilla Left wo 71550", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2314.75, "discounted_cash": 717.0, "minimum": 694.425, "maximum": 2314.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1906.22 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2314.75 } ] } ] }, { "description": "MA Galactogram Multi Duct Right Digital", "code_information": [ { "code": "77054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 577.75, "discounted_cash": 179.0, "minimum": 173.325, "maximum": 524.0193, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 325.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 440.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 440.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 408.91 } ] } ] }, { "description": "REM FB FOOT SUBQ FAC", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3522.75, "discounted_cash": 1092.0, "minimum": 1056.825, "maximum": 3195.1343, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 3522.75, "10th_percentile": 3522.75, "90th_percentile": 3522.75, "count": "1 through 10" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26831.0, "minimum": 26831.38, "maximum": 128194.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 128194.55 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6224.0, "minimum": 6224.88, "maximum": 18717.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18717.36 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "758", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7727.0, "minimum": 7727.44, "maximum": 11541.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11541.41 } ] } ] }, { "description": "MHA-TP", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.75, "discounted_cash": 67.0, "minimum": 65.325, "maximum": 197.4992, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 107.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 83.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.42 } ] } ] }, { "description": "NONTRAUMATIC STUPOR AND COMA WITHOUT MCC", "code_information": [ { "code": "081", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6010.0, "minimum": 6010.23, "maximum": 10558.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10558.21 } ] } ] }, { "description": "US Amniocentesis", "code_information": [ { "code": "76946", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 857.25, "discounted_cash": 265.0, "minimum": 106.5, "maximum": 777.5258, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.7 } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "117", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 12789.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12789.86 } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [ { "code": "058", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9873.0, "minimum": 9873.95, "maximum": 20153.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20153.26 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [ { "code": "178", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 6654.18, "maximum": 20340.2187, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6654.18, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2291.58, "10th_percentile": 2291.58, "90th_percentile": 2291.58, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11506.04 } ] } ] }, { "description": "Rabies Virus Vaccine, HDC For Inj Susp", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "49281025251", "type": "NDC" }, { "code": "90675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1667.65, "10th_percentile": 1312.4, "90th_percentile": 1682.87, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 709.68, "10th_percentile": 709.68, "90th_percentile": 709.68, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 1780.71, "10th_percentile": 1780.71, "90th_percentile": 1780.71, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1707.44, "10th_percentile": 1707.44, "90th_percentile": 1707.44, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1682.87, "10th_percentile": 1682.87, "90th_percentile": 1682.87, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 312.03, "10th_percentile": 312.03, "90th_percentile": 313.68, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 661.98, "10th_percentile": 521.66, "90th_percentile": 661.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1991.61, "10th_percentile": 1972.04, "90th_percentile": 1991.61, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "755", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6868.0, "minimum": 6868.83, "maximum": 12824.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12824.05 } ] } ] }, { "description": "MRI Angio Abdomen w+wo Contrast", "code_information": [ { "code": "74185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2499.75, "discounted_cash": 774.0, "minimum": 749.925, "maximum": 2340.82, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2340.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2340.82 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.04 } ] } ] }, { "description": "Thyroglobulin Ab", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.75, "discounted_cash": 59.0, "minimum": 57.225, "maximum": 173.0103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 119.7, "10th_percentile": 119.7, "90th_percentile": 119.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 85.84, "10th_percentile": 85.84, "90th_percentile": 85.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 115.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 62.26, "10th_percentile": 62.26, "90th_percentile": 62.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 89.21 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 144.07, "10th_percentile": 144.07, "90th_percentile": 144.07, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 190.75, "10th_percentile": 180.0, "90th_percentile": 190.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 57.6, "10th_percentile": 57.6, "90th_percentile": 61.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 329.76, "10th_percentile": 329.76, "90th_percentile": 329.76, "count": "1 through 10" } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC", "code_information": [ { "code": "421", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298.0, "minimum": 7298.13, "maximum": 20483.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20483.35 } ] } ] }, { "description": "TUBE THORACOSTOMY FAC", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1511.75, "discounted_cash": 468.0, "minimum": 453.525, "maximum": 1371.1572, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1159.51, "10th_percentile": 1159.51, "90th_percentile": 1159.51, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 468.64, "10th_percentile": 468.64, "90th_percentile": 468.64, "count": "1 through 10" } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "714", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3219.0, "minimum": 3219.77, "maximum": 12465.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12465.67 } ] } ] }, { "description": "MA Stereo Clip Spec Tomo Lt 77061 19284", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.5, "discounted_cash": 124.0, "minimum": 120.45, "maximum": 401.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 307.95, "10th_percentile": 307.95, "90th_percentile": 310.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 180.68, "10th_percentile": 180.68, "90th_percentile": 180.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.05, "10th_percentile": 131.05, "90th_percentile": 131.05, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 321.36, "10th_percentile": 315.3, "90th_percentile": 321.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 267.0, "10th_percentile": 267.0, "90th_percentile": 267.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 60.8, "10th_percentile": 60.8, "90th_percentile": 60.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 364.16, "10th_percentile": 364.16, "90th_percentile": 364.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.48, "10th_percentile": 128.48, "90th_percentile": 128.48, "count": "1 through 10" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "869", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 5151.62, "maximum": 8602.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8602.42 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2790.0, "minimum": 2790.46, "maximum": 7474.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7474.21 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4507.0, "minimum": 4507.67, "maximum": 9753.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9753.02 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21035.0, "minimum": 21035.8, "maximum": 50608.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50608.91 } ] } ] }, { "description": "99285 - Level 5", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2545.75, "discounted_cash": 789.0, "minimum": 763.725, "maximum": 2545.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 1472.14, "10th_percentile": 1472.14, "90th_percentile": 1472.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 996.19, "10th_percentile": 996.19, "90th_percentile": 1145.59, "count": "60" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 2545.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2545.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 722.57, "10th_percentile": 722.57, "90th_percentile": 830.93, "count": "74" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 2545.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 2036.6, "10th_percentile": 907.64, "90th_percentile": 2084.97, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 1999.18, "10th_percentile": 1771.89, "90th_percentile": 1999.18, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.78, "median_amount": 2031.0, "10th_percentile": 1766.13, "90th_percentile": 3220.12, "count": "31" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 1576.79, "10th_percentile": 631.35, "90th_percentile": 2545.75, "count": "80" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1713.44, "10th_percentile": 752.71, "90th_percentile": 1952.59, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 2545.75, "10th_percentile": 2213.75, "90th_percentile": 2545.75, "count": "338" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 814.64, "10th_percentile": 708.4, "90th_percentile": 814.64, "count": "224" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1766.13, "10th_percentile": 125.0, "90th_percentile": 2309.0, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 814.64, "10th_percentile": 110.0, "90th_percentile": 814.64, "count": "144" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 814.64, "10th_percentile": 708.4, "90th_percentile": 814.64, "count": "65" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 814.64, "10th_percentile": 708.4, "90th_percentile": 814.64, "count": "16" } ] } ] }, { "description": "LONG LEG SPLINT FAC", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.25, "discounted_cash": 55.0, "minimum": 54.075, "maximum": 163.4868, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 163.49, "10th_percentile": 163.49, "90th_percentile": 163.49, "count": "1 through 10" } ] } ] }, { "description": "Drug Monitoring, Phosphatatidylethanol (Peth), Blood - G0480 - 3351254", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 382.5, "minimum": 84.675, "maximum": 382.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 334.95, "10th_percentile": 133.46, "90th_percentile": 929.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 540.68, "10th_percentile": 78.3, "90th_percentile": 572.96, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 66.24, "median_amount": 511.41, "10th_percentile": 495.07, "90th_percentile": 511.41, "count": "34" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 392.17, "10th_percentile": 56.79, "90th_percentile": 415.59, "count": "31" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 104.46, "10th_percentile": 104.46, "90th_percentile": 764.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 331.37, "10th_percentile": 131.47, "90th_percentile": 999.88, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 382.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 784.82, "10th_percentile": 164.25, "90th_percentile": 1151.05, "count": "46" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 1201.5, "10th_percentile": 164.25, "90th_percentile": 1273.25, "count": "521" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 120.32, "10th_percentile": 52.56, "90th_percentile": 407.44, "count": "38" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 312.69, "10th_percentile": 312.69, "90th_percentile": 312.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 775.51, "10th_percentile": 261.27, "90th_percentile": 801.13, "count": "30" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 407.44, "10th_percentile": 384.48, "90th_percentile": 407.44, "count": "25" } ] } ] }, { "description": "Bill IRL Agsc Pt Serum", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.5, "discounted_cash": 93.0, "minimum": 60.82, "maximum": 274.3675, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.31 } ] } ] }, { "description": "Community Work Training/15 min OT", "code_information": [ { "code": "97537", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.75, "discounted_cash": 28.0, "minimum": 27.225, "maximum": 90.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.75 } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "708", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3005.0, "minimum": 3005.11, "maximum": 18086.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18086.65 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 28233.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28233.43 } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "601", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4936.0, "minimum": 4936.97, "maximum": 7132.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7132.33 } ] } ] }, { "description": "XR Ribs Left wo Chest Film", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.75, "discounted_cash": 132.0, "minimum": 86.08, "maximum": 387.0623, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 192.04, "10th_percentile": 192.04, "90th_percentile": 192.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 131.38, "10th_percentile": 131.38, "90th_percentile": 131.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.55 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 322.16, "10th_percentile": 322.16, "90th_percentile": 322.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 426.75, "10th_percentile": 426.75, "90th_percentile": 426.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 128.8, "10th_percentile": 128.8, "90th_percentile": 128.8, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10303.0, "minimum": 10303.25, "maximum": 25632.0487, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 10766.88, "standard_charge_algorithm": "2243.1 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13566.98, "10th_percentile": 13566.98, "90th_percentile": 17217.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 10303.25, "standard_charge_algorithm": "2146.51 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11457.9, "10th_percentile": 11457.9, "90th_percentile": 11457.9, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20572.95 } ] } ] }, { "description": "XR Sinuses Complete 3-4 Views", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.25, "discounted_cash": 177.0, "minimum": 106.5, "maximum": 518.1237, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.26 } ] } ] }, { "description": "75820 FAC VENOGRAPHY EXT UNILATERAL", "code_information": [ { "code": "75820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2650.75, "discounted_cash": 821.0, "minimum": 331.16, "maximum": 2404.2303, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 331.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 448.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 448.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.0 } ] } ] }, { "description": "Arbovirus IgM Ab, CSF", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.5, "discounted_cash": 32.0, "minimum": 31.35, "maximum": 104.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.5 } ] } ] }, { "description": "US Non Obstet Limited Transvag", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.5, "discounted_cash": 178.0, "minimum": 172.35, "maximum": 574.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.7, "median_amount": 360.43, "10th_percentile": 360.43, "90th_percentile": 360.43, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 464.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 176.91, "10th_percentile": 176.91, "90th_percentile": 176.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 464.23 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.6, "median_amount": 344.71, "10th_percentile": 344.71, "90th_percentile": 344.71, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.53, "median_amount": 433.82, "10th_percentile": 433.82, "90th_percentile": 451.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 574.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 173.44, "10th_percentile": 173.44, "90th_percentile": 173.44, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 440.64, "10th_percentile": 440.64, "90th_percentile": 440.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 32.4, "median_amount": 574.5, "10th_percentile": 542.0, "90th_percentile": 574.5, "count": "57" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 173.44, "10th_percentile": 173.44, "90th_percentile": 183.84, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 521.07, "10th_percentile": 432.41, "90th_percentile": 521.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.0, "median_amount": 183.84, "10th_percentile": 173.44, "90th_percentile": 521.07, "count": "1 through 10" } ] } ] }, { "description": "Luteinizing Hormone, Male", "code_information": [ { "code": "83002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.0, "discounted_cash": 71.0, "minimum": 69.3, "maximum": 209.517, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 152.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 172.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.64 } ] } ] }, { "description": "88161 AP Bill Gyn Cyto Prep Scrn Interp", "code_information": [ { "code": "88161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.25, "discounted_cash": 35.0, "minimum": 33.975, "maximum": 113.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.25 } ] } ] }, { "description": "Lidocaine Inj 1% w/ Epinephrine-1:100000", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323048203", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 17.15, "10th_percentile": 17.15, "90th_percentile": 17.15, "count": "1 through 10" } ] } ] }, { "description": "SLP Tx Generating Device Units", "code_information": [ { "code": "92609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 762.75, "discounted_cash": 236.0, "minimum": 95.0, "maximum": 691.8143, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "MRI Ankle Arthro Left 73722", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2657.5, "discounted_cash": 823.0, "minimum": 797.25, "maximum": 2410.3525, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2340.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2340.82 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2086.88 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4078.0, "minimum": 4078.37, "maximum": 8274.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8274.69 } ] } ] }, { "description": "REHABILITATION WITHOUT CCMCC", "code_information": [ { "code": "946", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9444.0, "minimum": 9444.64, "maximum": 13519.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13519.6 } ] } ] } ] }