{ "hospital_name": "Central Maine Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Central Maine Medical Center" ], "hospital_address": [ "300 Main Street, Lewiston, ME 04240" ], "license_information": { "license_number": "39666", "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": [ "1689653487", "1073651576" ], "standard_charge_information": [ { "description": "REMOVE FB FOOT DEEP FAC", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1559.75, "discounted_cash": 1629.0, "minimum": 467.925, "maximum": 2787.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1559.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [ { "code": "805", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9255.0, "minimum": 6907.49, "maximum": 19500.9713, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 11327.68, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12524.12, "10th_percentile": 12524.12, "90th_percentile": 12524.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15887.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19500.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 15600.76 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 11005.89, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11511.62, "10th_percentile": 11511.62, "90th_percentile": 11511.62, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11317.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6907.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9255.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11318.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9255.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12002.52 } ] } ] }, { "description": "23071 O EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/> (RH)", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3525.75, "discounted_cash": 1629.0, "minimum": 1057.725, "maximum": 3525.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3525.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3525.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3525.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "40805 O RMVL EMBEDDED FB VESTIBULE MOUTH COMP (RH)", "code_information": [ { "code": "40805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2077.0, "discounted_cash": 532.0, "minimum": 532.15, "maximum": 2077.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2077.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2077.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2037.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Glucose, Fasting", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.5, "discounted_cash": 3.0, "minimum": 3.8192, "maximum": 57.988, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44.4, "10th_percentile": 37.3, "90th_percentile": 44.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 35.35, "10th_percentile": 35.35, "90th_percentile": 35.35, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 38.05, "10th_percentile": 37.33, "90th_percentile": 44.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.57, "10th_percentile": 17.57, "90th_percentile": 17.57, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 48.4, "10th_percentile": 20.62, "90th_percentile": 48.84, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "854", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16244.0, "minimum": 13829.51, "maximum": 54222.2694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 48812.48, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 57996.71, "10th_percentile": 57996.71, "90th_percentile": 57996.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 29415.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36105.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 28884.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 46138.67, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 35793.77, "10th_percentile": 35793.77, "90th_percentile": 35793.77, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30364.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13829.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16244.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30365.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16244.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22222.23 } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 80 MG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00075062201", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "58120 O DILATION & CURETTAGE DX&/THER NONOBSTETRIC (RH)", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.0, "discounted_cash": 3194.0, "minimum": 578.7, "maximum": 1929.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1412.64, "10th_percentile": 1412.64, "90th_percentile": 1412.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1929.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 750 MG/150ML", "drug_information": { "unit": 150.0, "type": "ML" }, "code_information": [ { "code": "00409444401", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" } ] } ] }, { "description": "US Retroperitoneal Complete", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 948.75, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 827.31, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 102.92, "10th_percentile": 102.92, "90th_percentile": 827.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 288.36, "10th_percentile": 288.36, "90th_percentile": 296.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 695.77, "10th_percentile": 695.77, "90th_percentile": 723.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 646.43 } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "756", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8353.0, "minimum": 6609.87, "maximum": 20773.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14140.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17356.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13884.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20773.27 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6609.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20773.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10682.37 } ] } ] }, { "description": "Atypical P-ANCA Titer", "code_information": [ { "code": "86021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.0, "discounted_cash": 15.0, "minimum": 14.6256, "maximum": 53.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 44.0, "10th_percentile": 44.0, "90th_percentile": 46.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "40500 O VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT (RH)", "code_information": [ { "code": "40500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3513.75, "discounted_cash": 3271.0, "minimum": 1054.125, "maximum": 3513.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3513.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3513.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3513.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3513.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3513.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "43265 FAC IR ERCP LITHO", "code_information": [ { "code": "43265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5721.25, "discounted_cash": 5990.0, "minimum": 1716.375, "maximum": 5721.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "81003 O URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY (RH)", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.75, "discounted_cash": 2.0, "minimum": 2.1865, "maximum": 44.036, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 40.4, "10th_percentile": 33.94, "90th_percentile": 51.8, "count": "38" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 32.17, "10th_percentile": 32.17, "90th_percentile": 41.25, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 10.06, "10th_percentile": 10.06, "90th_percentile": 51.8, "count": "13" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.46, "10th_percentile": 40.33, "90th_percentile": 56.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15231.0, "minimum": 12848.06, "maximum": 57764.4749, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 52001.28, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15945.18, "10th_percentile": 15945.18, "90th_percentile": 15945.18, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 27454.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33698.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 26958.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32969.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12848.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32969.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 15231.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20740.82 } ] } ] }, { "description": "CL TRMT FEMORAL FRCT FAC", "code_information": [ { "code": "27267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4303.25, "discounted_cash": 3228.0, "minimum": 1290.975, "maximum": 4303.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4303.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4303.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4303.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4303.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occult Blood, Stool", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 4.0, "minimum": 4.1107, "maximum": 38.368, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 18.91, "10th_percentile": 18.91, "90th_percentile": 18.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 38.37, "10th_percentile": 38.37, "90th_percentile": 38.37, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "APPLY FOREARM CAST FAC", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1037.75, "discounted_cash": 275.0, "minimum": 134.325, "maximum": 1037.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1037.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1037.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1037.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PSA, Free", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.0, "discounted_cash": 18.0, "minimum": 17.8714, "maximum": 280.784, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 18.39, "10th_percentile": 18.39, "90th_percentile": 280.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.2, "10th_percentile": 82.2, "90th_percentile": 82.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 205.11, "10th_percentile": 205.11, "90th_percentile": 205.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 82.2, "10th_percentile": 82.2, "90th_percentile": 82.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH MCC", "code_information": [ { "code": "796", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9923.0, "minimum": 7343.53, "maximum": 25238.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17180.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21087.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 16869.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25238.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7343.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9923.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25238.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9923.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12979.0 } ] } ] }, { "description": "SHORT LEG SPLINT FAC", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.25, "discounted_cash": 160.0, "minimum": 68.175, "maximum": 295.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 178.39, "10th_percentile": 178.39, "90th_percentile": 178.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 227.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 227.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 168.31, "10th_percentile": 168.31, "90th_percentile": 168.31, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 198.16, "10th_percentile": 174.21, "90th_percentile": 198.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 227.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [ { "code": "902", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15608.0, "minimum": 13133.92, "maximum": 40393.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 28184.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34594.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 27675.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40393.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13133.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40393.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21292.46 } ] } ] }, { "description": "C9775 FAC REVASC LITH STEN ATH TIB PER", "code_information": [ { "code": "C9775", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56815.25, "discounted_cash": 18087.0, "minimum": 17044.575, "maximum": 56815.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56815.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56815.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56815.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37193 FAC REMV VENA CAVA FLTR", "code_information": [ { "code": "37193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9045.25, "discounted_cash": 3115.0, "minimum": 2713.575, "maximum": 9045.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9045.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9045.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9045.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [ { "code": "794", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12272.0, "minimum": 4437.1699, "maximum": 60283.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 5936.9, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4045.18, "10th_percentile": 1059.76, "90th_percentile": 19615.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 21727.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26669.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21335.4 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 5768.25, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7127.62, "10th_percentile": 7127.62, "90th_percentile": 7127.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 5786.4, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5642.72, "10th_percentile": 2781.86, "90th_percentile": 13236.93, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 60283.79 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 6579.75, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5346.4, "10th_percentile": 5346.4, "90th_percentile": 5346.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10217.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12272.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60283.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 6594.87, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4115.56, "10th_percentile": 1472.42, "90th_percentile": 12277.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12272.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16414.49 } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "583", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14162.0, "minimum": 11369.67, "maximum": 56858.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 25385.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31159.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 24927.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56858.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11369.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56858.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19178.22 } ] } ] }, { "description": "Occ Med Protein Electrophoresis, 24-Hour Urine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 5.0, "minimum": 5.0339, "maximum": 70.196, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.4, "10th_percentile": 54.1, "90th_percentile": 64.4, "count": "30" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.28, "10th_percentile": 51.28, "90th_percentile": 51.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 55.19, "10th_percentile": 54.15, "90th_percentile": 55.19, "count": "48" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.15, "10th_percentile": 23.15, "90th_percentile": 23.15, "count": "22" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 70.84, "10th_percentile": 70.84, "90th_percentile": 70.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Nocturnal Desaturation Study", "code_information": [ { "code": "94762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.25, "discounted_cash": 126.0, "minimum": 40.35, "maximum": 146.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 146.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC ARTHROSCOPY BICEPS TENODESIS ASC", "code_information": [ { "code": "29828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10070.5, "discounted_cash": 7159.0, "minimum": 3021.15, "maximum": 10070.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 7505.4, "10th_percentile": 7505.4, "90th_percentile": 7505.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 7680.77, "10th_percentile": 7680.77, "90th_percentile": 7680.77, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11576.0, "minimum": 10450.52, "maximum": 29940.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 20380.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25015.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 20012.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29940.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10450.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29940.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11576.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15396.85 } ] } ] }, { "description": "XR Fluoro Guide Needle Placmnt", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1437.75, "minimum": 431.325, "maximum": 1253.718, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 345.49, "10th_percentile": 345.49, "90th_percentile": 386.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 786.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1253.72, "10th_percentile": 1253.72, "90th_percentile": 1253.72, "count": "1 through 10" } ] } ] }, { "description": "Crystal Analysis-Synovial Fluid", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.25, "discounted_cash": 7.0, "minimum": 7.1233, "maximum": 87.418, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 75.6, "10th_percentile": 75.6, "90th_percentile": 75.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 63.86, "10th_percentile": 63.86, "90th_percentile": 63.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 87.42, "10th_percentile": 87.42, "90th_percentile": 87.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25213.0, "minimum": 19116.71, "maximum": 68716.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 46776.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57415.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 45932.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 68716.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19116.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68716.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 25213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35338.03 } ] } ] }, { "description": "37241 FAC VASC EMBOLIZATN OCCLUSN VENOUS", "code_information": [ { "code": "37241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27743.25, "discounted_cash": 11390.0, "minimum": 8322.975, "maximum": 27743.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27743.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27743.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27743.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INCISE HEMORRHOID EXT FAC", "code_information": [ { "code": "46083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 825.5, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1122.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 825.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 825.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 825.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [ { "code": "908", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16222.0, "minimum": 13961.01, "maximum": 86590.8208, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 29372.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36052.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 28842.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 75975.5, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 194291.5, "10th_percentile": 194291.5, "90th_percentile": 194291.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33347.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13961.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33347.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 86590.82, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 86474.26, "10th_percentile": 86474.26, "90th_percentile": 86474.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22189.98 } ] } ] }, { "description": "57800 O DILATION CERVICAL CANAL INSTRUMENTAL SPX (RH)", "code_information": [ { "code": "57800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.75, "discounted_cash": 3194.0, "minimum": 126.825, "maximum": 422.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Soft Tissue Head Neck", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 745.996, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 645.6, "10th_percentile": 645.6, "90th_percentile": 645.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 511.64, "10th_percentile": 511.64, "90th_percentile": 1023.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 627.36, "10th_percentile": 627.36, "90th_percentile": 652.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 737.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 326.62, "10th_percentile": 326.62, "90th_percentile": 645.6, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 710.16, "10th_percentile": 102.92, "90th_percentile": 746.0, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ethosuximide Level", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.75, "discounted_cash": 16.0, "minimum": 13.725, "maximum": 45.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIV Phenosense Entry", "code_information": [ { "code": "87903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2476.0, "discounted_cash": 488.0, "minimum": 474.8798, "maximum": 2476.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 593.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 474.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2476.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 826.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "H influenza B Ab, IgG", "code_information": [ { "code": "86684", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.5, "discounted_cash": 15.0, "minimum": 15.3933, "maximum": 214.076, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Angiotensin Converting Enzyme, Serum", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.75, "discounted_cash": 14.0, "minimum": 14.1883, "maximum": 195.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 65.26, "10th_percentile": 65.26, "90th_percentile": 65.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 142.53, "10th_percentile": 142.53, "90th_percentile": 142.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 153.4, "10th_percentile": 150.52, "90th_percentile": 153.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 14.6, "10th_percentile": 14.6, "90th_percentile": 195.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "43762 O REPLACE GTUBE PERCUT NO REV TRC (RH)", "code_information": [ { "code": "43762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1018.5, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1041.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1018.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 92448.0, "minimum": 88751.4, "maximum": 236027.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 176921.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 217161.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 173729.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 236026.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90681.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 92448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 236027.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 92448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 133659.24 } ] } ] }, { "description": "CYSTO W/SIMPLE REMOVAL STONE & STENT FAC", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7513.25, "discounted_cash": 2062.0, "minimum": 1144.8, "maximum": 7513.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7513.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7513.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7513.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Stone Extraction Renal-Ureteral", "code_information": [ { "code": "50080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8436.75, "discounted_cash": 9340.0, "minimum": 2531.025, "maximum": 8436.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8436.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Nephrostomy Tract Percutaneous", "code_information": [ { "code": "50437", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1667.75, "discounted_cash": 3478.0, "minimum": 500.325, "maximum": 1667.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1667.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "20520 O REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE (RH)", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1331.0, "discounted_cash": 1629.0, "minimum": 178.5, "maximum": 1331.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Spectroscopy 76390", "code_information": [ { "code": "76390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1928.75, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 1928.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "23655 O CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES (RH)", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3188.75, "discounted_cash": 1586.0, "minimum": 277.35, "maximum": 3188.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3188.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3188.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3188.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9080.0, "minimum": 7404.44, "maximum": 23486.3249, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15548.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19085.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 15268.28 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 20542.45, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16084.56, "10th_percentile": 16084.56, "90th_percentile": 16084.56, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17480.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7404.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9080.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17480.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9080.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11746.72 } ] } ] }, { "description": "MRI Non-conditional approval 76016", "code_information": [ { "code": "76016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.25, "discounted_cash": 85.0, "minimum": 79.275, "maximum": 264.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 264.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 264.25, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "41010 O INCISION LINGUAL FRENUM FRENOTOMY (RH)", "code_information": [ { "code": "41010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1289.25, "discounted_cash": 1530.0, "minimum": 386.775, "maximum": 2727.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1289.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC TREAT LOWER LEG JOINT ASC", "code_information": [ { "code": "27829", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13510.25, "discounted_cash": 7159.0, "minimum": 4053.075, "maximum": 13510.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13510.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13510.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13510.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 10304.27, "10th_percentile": 10304.27, "90th_percentile": 10304.27, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "46255 O HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP (RH)", "code_information": [ { "code": "46255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3152.0, "discounted_cash": 2738.0, "minimum": 945.6, "maximum": 3152.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3152.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3152.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3152.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2985.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3152.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 6.0, "minimum": 6.6957, "maximum": 82.404, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 63.5, "10th_percentile": 63.5, "90th_percentile": 75.6, "count": "33" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 60.2, "10th_percentile": 60.2, "90th_percentile": 60.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 63.57, "10th_percentile": 63.57, "90th_percentile": 64.79, "count": "63" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 75.6, "count": "22" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 36.15, "10th_percentile": 36.15, "90th_percentile": 36.15, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15272.0, "minimum": 13369.24, "maximum": 57018.5336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 27533.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33796.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 27036.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30236.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13369.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15272.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30236.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 15272.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20800.88 } ] } ] }, { "description": "XR Abdomen 3+ Views 74021", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 536.498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "42808 O EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD (RH)", "code_information": [ { "code": "42808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1585.0, "discounted_cash": 3271.0, "minimum": 475.5, "maximum": 1585.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1585.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "419", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11435.0, "minimum": 9119.54, "maximum": 37215.3328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 20106.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24679.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 19743.81 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 32550.61, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 30565.32, "10th_percentile": 30565.32, "90th_percentile": 30565.32, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31089.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9119.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11435.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31089.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11435.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15189.99 } ] } ] }, { "description": "88177 AP Bill Cyto FNA Tech Additional", "code_information": [ { "code": "88177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.5, "minimum": 34.65, "maximum": 100.716, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 316.75, "10th_percentile": 316.75, "90th_percentile": 316.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.15 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CCMCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6790.0, "minimum": 5327.35, "maximum": 22014.5444, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11114.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13642.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10914.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11814.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5327.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6790.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11814.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6790.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8396.87 } ] } ] }, { "description": "Nitrogen Washout/Lung Volumes", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.0, "discounted_cash": 213.0, "minimum": 177.9, "maximum": 593.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 593.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 593.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 593.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med PSA (Prostate Specific Antigen) MCR", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 19.0, "minimum": 15.0, "maximum": 161.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 19.31, "10th_percentile": 19.31, "90th_percentile": 19.31, "count": "40" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" } ] } ] }, { "description": "Metanephrines, Plasma", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 841.75, "discounted_cash": 16.0, "minimum": 16.4623, "maximum": 734.006, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 673.4, "10th_percentile": 673.4, "90th_percentile": 673.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 162.44, "10th_percentile": 162.44, "90th_percentile": 162.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 75.72, "10th_percentile": 75.72, "90th_percentile": 75.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 740.74, "10th_percentile": 740.74, "90th_percentile": 740.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium-Dextrose IV Solution 2 GM/100ML-4%", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338350841", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" } ] } ] }, { "description": "EEG AWAKE/SLEEP", "code_information": [ { "code": "95819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1776.25, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1548.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 301.39, "10th_percentile": 301.39, "90th_percentile": 1548.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chemo Administraion SC/IM Non Hormonal", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.75, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 365.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 267.96, "10th_percentile": 267.96, "90th_percentile": 638.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "95810 POLYSOM 6/> YRS 4/> PARAM REDUCED", "code_information": [ { "code": "95810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4735.75, "discounted_cash": 847.0, "minimum": 847.32, "maximum": 4129.574, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3338.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4055.02, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3244.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 923.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1432.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "96138 O TECH PSYCH/ N PSYCH 2+ TESTS 1ST 30 MIN (RH)", "code_information": [ { "code": "96138", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 257.0, "discounted_cash": 440.0, "minimum": 77.1, "maximum": 257.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23454.0, "minimum": 20052.48, "maximum": 59105.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 43371.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 53235.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 42588.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 59105.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20052.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23454.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59105.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 23454.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32765.58 } ] } ] }, { "description": "PATIENT SUPPLIED MED - AMB OMALIZUMAB (RH)", "code_information": [ { "code": "J2357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 0.01, "discounted_cash": 45.0, "minimum": 1.0, "maximum": 217.7446, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 217.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 174.2, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 45.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 45.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27869.0, "minimum": 23706.94, "maximum": 125395.9357, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 51916.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 63725.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 50980.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 75178.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23706.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75178.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 27869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39221.72 } ] } ] }, { "description": "36253 FAC ANGIOGR RENAL 2ND + UNI", "code_information": [ { "code": "36253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7231.25, "discounted_cash": 5490.0, "minimum": 2169.375, "maximum": 7231.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "465", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14918.0, "minimum": 12016.12, "maximum": 43845.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 26847.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32953.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 26363.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43845.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12016.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43845.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 31785.66, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 31645.6, "10th_percentile": 31645.6, "90th_percentile": 31645.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20282.61 } ] } ] }, { "description": "46505 O CHEMODENERVATION INTERNAL ANAL SPHINCTER (RH)", "code_information": [ { "code": "46505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2115.5, "discounted_cash": 1180.0, "minimum": 634.65, "maximum": 2115.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1214.74, "10th_percentile": 1214.74, "90th_percentile": 5164.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2115.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2115.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2115.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1287.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1996.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "25111 O EX GANGLION WRIST (RH)", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2001.25, "discounted_cash": 1586.0, "minimum": 600.375, "maximum": 2430.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2001.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2001.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2001.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2001.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Venogram Epidural", "code_information": [ { "code": "75872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1408.25, "discounted_cash": 618.0, "minimum": 422.475, "maximum": 1408.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1408.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1408.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1408.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 658.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REM FB MOUTH SIMPL FAC", "code_information": [ { "code": "40804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.5, "discounted_cash": 894.0, "minimum": 79.35, "maximum": 1278.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 264.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REVISE EYE SOCKET FAC", "code_information": [ { "code": "67560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10497.0, "discounted_cash": 3879.0, "minimum": 3149.1, "maximum": 10497.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10497.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10497.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10497.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4228.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6560.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "42104 O EXC LESION PALATE UVULA W/O CLOSURE (RH)", "code_information": [ { "code": "42104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1343.75, "discounted_cash": 3271.0, "minimum": 403.125, "maximum": 1343.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1343.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6662.0, "minimum": 4925.91, "maximum": 13339.1559, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 9564.18, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8139.57, "10th_percentile": 8139.57, "90th_percentile": 8139.57, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 10867.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13339.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10671.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8455.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4925.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8455.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6662.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8210.02 } ] } ] }, { "description": "XR Sternoclavicular Joints Min 3 Views", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.75, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 85.22, "10th_percentile": 85.22, "90th_percentile": 85.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "10030 O GUIDE CATHETER FLUID DRAINAGE (RH)", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1847.25, "discounted_cash": 698.0, "minimum": 189.6, "maximum": 1847.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1847.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1847.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1847.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "26700 O CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES (RH)", "code_information": [ { "code": "26700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1944.5, "discounted_cash": 243.0, "minimum": 117.0, "maximum": 1695.604, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "28470 O CLOSED TX METATARSAL FRACTURE W/O MANIPULATION (RH)", "code_information": [ { "code": "28470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1589.5, "discounted_cash": 243.0, "minimum": 117.0, "maximum": 1386.044, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "853", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38607.0, "minimum": 34615.65, "maximum": 122246.2931, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 72703.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 89239.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 71391.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 84199.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34615.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38607.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 84199.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 38607.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54925.53 } ] } ] }, { "description": "PNH w/ Flaer (High Sensitivity)", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "minimum": 64.875, "maximum": 188.57, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.85 } ] } ] }, { "description": "MRI Additional 30 minutes implant 76015", "code_information": [ { "code": "76015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.5, "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": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [ { "code": "486", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16951.0, "minimum": 14679.45, "maximum": 43216.0787, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 30784.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37785.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 30228.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36056.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14679.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36056.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23256.55 } ] } ] }, { "description": "64681 O DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS (RH)", "code_information": [ { "code": "64681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1918.5, "discounted_cash": 872.0, "minimum": 575.55, "maximum": 1918.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1918.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1918.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1918.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ova and Parasites, Conc and Perm Smear", "code_information": [ { "code": "87209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 17.0, "minimum": 17.473, "maximum": 117.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 101.8, "10th_percentile": 101.8, "90th_percentile": 101.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 81.06, "10th_percentile": 81.06, "90th_percentile": 81.06, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 87.24, "10th_percentile": 87.24, "90th_percentile": 90.81, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 80.37, "10th_percentile": 80.37, "90th_percentile": 80.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 94.34, "10th_percentile": 17.98, "90th_percentile": 111.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1896) LEAD AICD NON SING/DUAL", "code_information": [ { "code": "C1896", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 13911.97, "10th_percentile": 13911.97, "90th_percentile": 13911.97, "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": 325.0, "minimum": 125.625, "maximum": 418.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 418.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 418.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 418.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 11186.85, "10th_percentile": 319.51, "90th_percentile": 11964.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 321.01, "10th_percentile": 321.01, "90th_percentile": 321.01, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 365.15, "10th_percentile": 365.15, "90th_percentile": 631.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 418.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chemo IV Infusion Each Addl Hr", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.75, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 254.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 195.27, "10th_percentile": 187.7, "90th_percentile": 195.27, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 248.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 181.68, "10th_percentile": 181.68, "90th_percentile": 381.38, "count": "18" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 195.27, "10th_percentile": 187.7, "90th_percentile": 195.27, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 381.38, "10th_percentile": 27.55, "90th_percentile": 437.8, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Hepatic Venogram w PRES 75889", "code_information": [ { "code": "75889", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7514.0, "discounted_cash": 3115.0, "minimum": 634.7443, "maximum": 7514.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7514.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7514.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7514.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INS CVAD WO PUMP PORT FAC", "code_information": [ { "code": "36565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6162.25, "discounted_cash": 3115.0, "minimum": 1848.675, "maximum": 6162.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6162.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6162.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6162.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 24020.0, "minimum": 19781.85, "maximum": 67794.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 44466.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 54579.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 43663.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 67794.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19781.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24020.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67794.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 24020.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33593.03 } ] } ] }, { "description": "46754 O RMVL THIERSCH WIRE/SUTURE ANAL CANAL (RH)", "code_information": [ { "code": "46754", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2089.0, "discounted_cash": 2738.0, "minimum": 626.7, "maximum": 2089.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Arthrogram", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 521.75, "discounted_cash": 394.0, "minimum": 156.525, "maximum": 521.75, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 521.75, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 521.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 521.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 521.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 521.75 } ] } ] }, { "description": "11042 O DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< (RH)", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 317.0, "discounted_cash": 401.0, "minimum": 95.1, "maximum": 614.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 317.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "41110 O EXCISION LESION TONGUE W/O CLOSURE (RH)", "code_information": [ { "code": "41110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1280.25, "discounted_cash": 3271.0, "minimum": 384.075, "maximum": 1280.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1280.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "358", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11679.0, "minimum": 9379.09, "maximum": 27820.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 20579.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25259.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 20207.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27820.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9379.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11679.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27820.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11679.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15547.0 } ] } ] }, { "description": "CT Spine Procedure", "code_information": [ { "code": "22899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.5, "discounted_cash": 243.0, "minimum": 153.75, "maximum": 512.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 512.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 512.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 512.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 512.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "28810 O AMPUTATION METATARSAL W/TOE (RH)", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3473.0, "discounted_cash": 3228.0, "minimum": 1041.9, "maximum": 5688.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3473.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3473.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3473.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3473.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3473.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med CONTRACT RATE Generic Sling", "code_information": [ { "code": "A4565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.25, "discounted_cash": 10.0, "minimum": 3.075, "maximum": 10.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fluoxetine Level", "code_information": [ { "code": "80332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "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": "White Blood Cell", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.0, "discounted_cash": 2.0, "minimum": 2.4684, "maximum": 50.576, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 48.18, "10th_percentile": 48.18, "90th_percentile": 50.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [ { "code": "823", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35917.0, "minimum": 32388.36, "maximum": 102093.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 67495.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 82846.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 66277.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 102093.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32388.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35917.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 102093.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 35917.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50990.68 } ] } ] }, { "description": "19100 O BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX (RH)", "code_information": [ { "code": "19100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.5, "discounted_cash": 1629.0, "minimum": 171.45, "maximum": 2040.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 571.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 13638.0, "minimum": 11128.11, "maximum": 47369.9612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 24370.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29912.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 23930.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31559.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11128.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13638.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31559.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13638.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18410.83 } ] } ] }, { "description": "HC (SUP SHELL C1760) CLOSURE DEVICE VASCULAR", "code_information": [ { "code": "C1760", "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": 87.2, "median_amount": 773.68, "10th_percentile": 773.68, "90th_percentile": 773.68, "count": "1 through 10" } ] } ] }, { "description": "Occ Med CONTRACT RATE Knee Splint / Immobolizer Hard", "code_information": [ { "code": "L1830", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.0, "discounted_cash": 74.0, "minimum": 13.8, "maximum": 46.0, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "XR TFESI C or T SPINE RIGHT 64479", "code_information": [ { "code": "64479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2944.75, "discounted_cash": 872.0, "minimum": 514.8, "maximum": 2944.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2944.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2944.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2944.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 125 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009004725", "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": 78.5, "median_amount": 43.31, "10th_percentile": 43.31, "90th_percentile": 159.45, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 53.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "1 through 10" } ] } ] }, { "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": 11262.0, "minimum": 8526.39, "maximum": 24269.6021, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19772.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24269.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 19415.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17147.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8526.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17147.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14937.53 } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17646.0, "minimum": 16006.27, "maximum": 72452.5616, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 32129.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39437.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 31549.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45741.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16006.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17646.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45741.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 17646.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24273.07 } ] } ] }, { "description": "Clonazepam (Klonopin) Level", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.25, "minimum": 84.5324, "maximum": 246.122, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.53 } ] } ] }, { "description": "10005 O NEEDLE ASP BIOPSY W US 1ST LESION (RH)", "code_information": [ { "code": "10005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 752.0, "discounted_cash": 698.0, "minimum": 225.6, "maximum": 3045.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 752.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 752.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 752.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 752.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 752.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "96367 IV INF NONCHEM EA", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.25, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 321.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 344.4, "10th_percentile": 344.4, "90th_percentile": 344.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 256.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 256.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 195.52, "10th_percentile": 195.52, "90th_percentile": 195.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 196.44, "10th_percentile": 196.44, "90th_percentile": 392.88, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 82.66, "10th_percentile": 66.16, "90th_percentile": 402.31, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 223.45, "10th_percentile": 68.88, "90th_percentile": 451.0, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [ { "code": "660", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11100.0, "minimum": 9274.58, "maximum": 31157.4768, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 28048.88, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21796.14, "10th_percentile": 21796.14, "90th_percentile": 21796.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19457.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23882.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 19106.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23931.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9274.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11100.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23931.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11100.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14699.52 } ] } ] }, { "description": "43261 FAC IR ERCP BX", "code_information": [ { "code": "43261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5149.25, "discounted_cash": 3804.0, "minimum": 1544.775, "maximum": 5149.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5149.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5149.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5149.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5149.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "P jiro DFA", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "discounted_cash": 16.0, "minimum": 15.646, "maximum": 144.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 111.84, "10th_percentile": 111.84, "90th_percentile": 111.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13676.0, "minimum": 11506.71, "maximum": 48153.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 24445.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30004.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 24003.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48153.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11506.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48153.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18467.55 } ] } ] }, { "description": "Urine Sodium", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.5, "discounted_cash": 5.0, "minimum": 4.9173, "maximum": 44.036, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 22.62, "10th_percentile": 22.62, "90th_percentile": 22.62, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 34.62, "10th_percentile": 34.62, "90th_percentile": 34.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 44.04, "10th_percentile": 44.04, "90th_percentile": 44.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Inject Spider Veins", "code_information": [ { "code": "36468", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 478.75, "discounted_cash": 401.0, "minimum": 143.625, "maximum": 1144.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 478.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 478.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 478.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Vitamin D 25-Hydroxy Level", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.25, "discounted_cash": 29.0, "minimum": 28.7653, "maximum": 112.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 89.8, "10th_percentile": 75.43, "90th_percentile": 89.8, "count": "65" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.77, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 71.5, "10th_percentile": 71.5, "90th_percentile": 71.5, "count": "34" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 76.96, "10th_percentile": 75.51, "90th_percentile": 76.96, "count": "103" }, { "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": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 112.25, "10th_percentile": 89.8, "90th_percentile": 112.25, "count": "31" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 98.78, "10th_percentile": 98.78, "90th_percentile": 112.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "$ General Health Panel", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 576.5, "minimum": 172.95, "maximum": 502.708, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 430.65, "10th_percentile": 430.65, "90th_percentile": 430.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.15 } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "581", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12023.0, "minimum": 9961.18, "maximum": 47144.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 21244.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26076.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 20861.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47144.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9961.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47144.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16049.7 } ] } ] }, { "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": 10.8453, "maximum": 37.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.52, "10th_percentile": 23.52, "90th_percentile": 28.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 23.57, "10th_percentile": 22.3, "90th_percentile": 23.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 35.0, "10th_percentile": 35.0, "90th_percentile": 35.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 30.8, "10th_percentile": 11.16, "90th_percentile": 58.56, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VL Non Invasive Ext Upper/Lower Single Level ABI - Vascular US Charges", "code_information": [ { "code": "93922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 728.25, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 635.034, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 571.68, "10th_percentile": 571.68, "90th_percentile": 571.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 628.22, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 555.44, "10th_percentile": 539.13, "90th_percentile": 555.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 558.28, "10th_percentile": 531.64, "90th_percentile": 558.28, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.68, "10th_percentile": 206.68, "90th_percentile": 206.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 124.75, "10th_percentile": 124.75, "90th_percentile": 635.03, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "30300 O REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE (RH)", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 914.5, "discounted_cash": 131.0, "minimum": 77.325, "maximum": 797.444, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 628.22, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK FAC", "code_information": [ { "code": "67935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6952.5, "discounted_cash": 2345.0, "minimum": 2085.75, "maximum": 6952.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6952.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6952.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6952.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2557.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3967.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "N-STATE 90698 DIPHTH/HAEM/PERT/TETAN/POLIO - AMB DIPHTH/HAEM/PERT/TETAN/POLIO (RH)", "code_information": [ { "code": "90698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 424.5, "minimum": 127.35, "maximum": 370.164, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.91 } ] } ] }, { "description": "Occ Med Mercury, Urine", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.0, "discounted_cash": 16.0, "minimum": 15.8015, "maximum": 204.266, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 72.68, "10th_percentile": 72.68, "90th_percentile": 72.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 160.6, "10th_percentile": 160.6, "90th_percentile": 160.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 206.14, "10th_percentile": 32.52, "90th_percentile": 206.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11601 O EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM (RH)", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 963.25, "discounted_cash": 698.0, "minimum": 288.975, "maximum": 963.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 963.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 963.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 963.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Vitamin B6 (Pyridoxal 5-Phosphate)", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.0, "discounted_cash": 28.0, "minimum": 27.3076, "maximum": 449.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 125.61, "10th_percentile": 125.61, "90th_percentile": 125.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.13, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.31, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 346.44, "10th_percentile": 346.44, "90th_percentile": 353.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 28.1, "10th_percentile": 28.1, "90th_percentile": 453.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "29355 O APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE (RH)", "code_information": [ { "code": "29355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 870.0, "discounted_cash": 275.0, "minimum": 261.0, "maximum": 870.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 870.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 870.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 870.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "33230 FAC INS PULS GEN W/EX DUAL LD", "code_information": [ { "code": "33230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95024.25, "discounted_cash": 21947.0, "minimum": 21947.8, "maximum": 95024.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86465.55, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95024.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84031.54, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23923.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37118.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36475 FAC ENDOVENOUS RF 1st VEIN", "code_information": [ { "code": "36475", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24232.5, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 21130.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14909.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydromorphone HCl-NaCl Soln Pref Syr 25 MG/50ML-0.9%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "09999408226", "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": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "IV Push Each Addl New Med", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.0, "discounted_cash": 46.0, "minimum": 34.05, "maximum": 287.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 264.0, "10th_percentile": 221.76, "90th_percentile": 887.04, "count": "19" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 487.66, "10th_percentile": 487.66, "90th_percentile": 487.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 641.26, "10th_percentile": 380.62, "90th_percentile": 1147.22, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 221.76, "10th_percentile": 138.38, "90th_percentile": 518.1, "count": "32" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 575.52, "10th_percentile": 287.76, "90th_percentile": 580.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "23570 O CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION (RH)", "code_information": [ { "code": "23570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1875.0, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 1635.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "98926 O OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS (RH)", "code_information": [ { "code": "98926", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.0, "discounted_cash": 21.0, "minimum": 21.31, "maximum": 252.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.95, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 24.49, "10th_percentile": 24.49, "90th_percentile": 24.49, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VIRAL ILLNESS WITH MCC", "code_information": [ { "code": "865", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12443.0, "minimum": 8879.8257, "maximum": 32063.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22057.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27074.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21659.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32063.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10039.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32063.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16663.61 } ] } ] }, { "description": "99211 FAC NURSE VIS L1 - INFUSION THERAPY", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "minimum": 8.775, "maximum": 95.92, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 96.8, "10th_percentile": 96.8, "90th_percentile": 96.8, "count": "1 through 10" } ] } ] }, { "description": "Fluzone (6mo+) 0.5mL Quad NS 90686 - AMB INFLU (RH)", "code_information": [ { "code": "90686", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.75, "minimum": 9.525, "maximum": 40.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.75 } ] } ] }, { "description": "US Spinal Canal", "code_information": [ { "code": "76800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 637.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 637.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 637.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TPMT Genetics, Prometheus", "code_information": [ { "code": "81401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1489.5, "discounted_cash": 137.0, "minimum": 133.1366, "maximum": 1298.844, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.41, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.14, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 718.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37188 FAC VENOUS M-THROMBECTOMY ADD", "code_information": [ { "code": "37188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10139.25, "discounted_cash": 3115.0, "minimum": 3041.775, "maximum": 10139.25, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10139.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10139.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10139.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSION WITHOUT MCC", "code_information": [ { "code": "305", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6790.0, "minimum": 5195.84, "maximum": 16111.4503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11116.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13644.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10915.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12286.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5195.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6790.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12286.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6790.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8397.98 } ] } ] }, { "description": "CSF Oligoclonal Bands", "code_information": [ { "code": "83916", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 27.0, "minimum": 26.6176, "maximum": 152.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.62, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9572.0, "minimum": 8025.28, "maximum": 31304.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 16501.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20254.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 16203.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31304.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8025.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9572.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31304.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9572.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12466.29 } ] } ] }, { "description": "67840 O EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE (RH)", "code_information": [ { "code": "67840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1720.0, "discounted_cash": 983.0, "minimum": 516.0, "maximum": 1720.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1720.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1720.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1720.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1072.15, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1663.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRT ANK FRC W MAN FAC", "code_information": [ { "code": "27762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.5, "discounted_cash": 1586.0, "minimum": 201.45, "maximum": 671.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EEG Coma or Sleep Only", "code_information": [ { "code": "95822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1187.75, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1035.718, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Tobra", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.75, "discounted_cash": 16.0, "minimum": 15.6751, "maximum": 189.006, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [ { "code": "974", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22997.0, "minimum": 20668.48, "maximum": 52149.5582, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 42486.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 52149.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 41719.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37180.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20668.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22997.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37180.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 22997.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32097.17 } ] } ] }, { "description": "Hepatitis B Surface Antigen - ECi", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.25, "discounted_cash": 10.0, "minimum": 10.0387, "maximum": 95.266, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.4, "10th_percentile": 46.18, "90th_percentile": 82.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 65.61, "10th_percentile": 65.61, "90th_percentile": 65.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.49, "10th_percentile": 70.62, "90th_percentile": 73.49, "count": "37" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 46.18, "10th_percentile": 46.18, "90th_percentile": 46.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 90.64, "10th_percentile": 90.64, "90th_percentile": 90.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Piperacillin Sod-Tazobactam Sod For Inj 2.25 GM (2-0.25 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150011930", "type": "NDC" }, { "code": "J2543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 72.41, "10th_percentile": 72.41, "90th_percentile": 72.41, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 85.34, "10th_percentile": 85.34, "90th_percentile": 170.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 99.93, "10th_percentile": 99.93, "90th_percentile": 99.93, "count": "1 through 10" } ] } ] }, { "description": "PT Evaluation Units, Moderate Complexity", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.75, "discounted_cash": 94.0, "minimum": 91.4075, "maximum": 366.894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 282.74, "10th_percentile": 282.74, "90th_percentile": 282.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.25, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.41, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 70.22, "10th_percentile": 70.22, "90th_percentile": 70.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RADIAL SHAFT MANI FAC", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.75, "discounted_cash": 1586.0, "minimum": 171.825, "maximum": 572.75, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 572.75, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "730", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6158.0, "minimum": 4200.56, "maximum": 14532.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 9892.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12142.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 9714.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14532.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4200.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6158.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14532.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6158.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7473.77 } ] } ] }, { "description": "56405 O I&D VULVA/PERINEAL ABSCESS (RH)", "code_information": [ { "code": "56405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1024.25, "discounted_cash": 300.0, "minimum": 107.325, "maximum": 1024.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1024.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1024.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1024.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 508.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5466.47, "maximum": 5466.47, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5466.47 } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITHOUT CCMCC", "code_information": [ { "code": "079", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4579.15, "maximum": 4579.15, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4579.15 } ] } ] }, { "description": "64510 O NJX ANES STELLATE GANGLION CRV SYMPATHETIC (RH)", "code_information": [ { "code": "64510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 835.75, "discounted_cash": 872.0, "minimum": 250.725, "maximum": 835.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 835.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [ { "code": "551", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13795.0, "minimum": 11810.56, "maximum": 32090.5112, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 24674.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30286.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 24229.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22158.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11810.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22158.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 32090.51, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 19557.11, "10th_percentile": 19557.11, "90th_percentile": 19557.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18641.05 } ] } ] }, { "description": "86317 IMMUNO INFECT QUANT (RH)", "code_information": [ { "code": "86317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.0, "discounted_cash": 14.0, "minimum": 10.8, "maximum": 91.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "27327 O EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM (RH)", "code_information": [ { "code": "27327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2981.75, "discounted_cash": 1629.0, "minimum": 894.525, "maximum": 2981.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2981.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2981.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2981.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Femur Right Min 2 Views", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 345.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 218.74, "10th_percentile": 218.74, "90th_percentile": 218.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 345.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 46.09, "10th_percentile": 46.09, "90th_percentile": 46.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 263.13, "10th_percentile": 263.13, "90th_percentile": 263.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 286.44, "10th_percentile": 85.86, "90th_percentile": 300.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Port Indwelling-Implantbl", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1791.25, "minimum": 537.375, "maximum": 1561.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1339.2, "10th_percentile": 1339.2, "90th_percentile": 1339.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1366.19, "10th_percentile": 1366.19, "90th_percentile": 1366.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1373.17, "10th_percentile": 1195.13, "90th_percentile": 1373.17, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1406.13, "10th_percentile": 1406.13, "90th_percentile": 1406.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1373.17, "10th_percentile": 1371.92, "90th_percentile": 1473.12, "count": "1 through 10" } ] } ] }, { "description": "62270 O SPINAL PUNCTURE LUMBAR DIAGNOSTIC (RH)", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 934.5, "discounted_cash": 696.0, "minimum": 227.625, "maximum": 934.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 934.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 934.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 934.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 719.85, "10th_percentile": 719.85, "90th_percentile": 719.85, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 934.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRMT FRACT W MANIPUL FAC", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703.0, "discounted_cash": 1586.0, "minimum": 210.9, "maximum": 703.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Asp Inj Small Joint Right 20604", "code_information": [ { "code": "20604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1091.5, "discounted_cash": 302.0, "minimum": 139.2, "maximum": 1091.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1091.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1091.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1091.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SMP RPR FC 12.6-20 FAC", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.5, "discounted_cash": 401.0, "minimum": 157.05, "maximum": 1017.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 523.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 523.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 523.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 523.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Angio Pelvis wo 72198", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2104.0, "minimum": 631.2, "maximum": 2104.0, "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": 2104.0 } ] } ] }, { "description": "57520 O CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER (RH)", "code_information": [ { "code": "57520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2467.0, "discounted_cash": 3194.0, "minimum": 740.1, "maximum": 2467.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2467.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACNE SURGERY FAC", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.25, "discounted_cash": 197.0, "minimum": 90.075, "maximum": 330.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FB AUD CANAL ANES FAC", "code_information": [ { "code": "69205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9318.5, "discounted_cash": 1629.0, "minimum": 1629.64, "maximum": 8125.732, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6420.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7798.97, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6239.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTElectrical Stim (Unattended) - Non-Wound MCR", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.5, "discounted_cash": 12.0, "minimum": 11.7199, "maximum": 122.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "97035 APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN (RH)", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.0, "discounted_cash": 13.0, "minimum": 13.2845, "maximum": 94.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FAC RMV PHARYNX FORN BODY", "code_information": [ { "code": "42809", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.75, "discounted_cash": 440.0, "minimum": 78.225, "maximum": 1199.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 260.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64479 O NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL (RH)", "code_information": [ { "code": "64479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1716.0, "discounted_cash": 872.0, "minimum": 514.8, "maximum": 2944.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1716.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1716.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1716.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Cerebrospinal Imaging Ventriculograph", "code_information": [ { "code": "78635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 990.0, "discounted_cash": 535.0, "minimum": 297.0, "maximum": 990.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UP TO 2.4 MU BILCILLIN LA J0561 - AMB PENICILLIN (RH)", "code_information": [ { "code": "J0561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.0, "discounted_cash": 31.0, "minimum": 31.965, "maximum": 204.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.93, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.97, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 122.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SALIVARY GLAND PROCEDURES", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10446.0, "minimum": 9502.99, "maximum": 26723.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 18191.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22328.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 17863.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26723.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9502.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10446.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26723.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10446.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13743.06 } ] } ] }, { "description": "HB ASC TRANSPLANT FOREARM TENDON EA TENDON ASC", "code_information": [ { "code": "25310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Limited Follow-up", "code_information": [ { "code": "76380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 641.25, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 641.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITH CCMCC", "code_information": [ { "code": "135", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17551.0, "minimum": 16688.02, "maximum": 46929.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 31945.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39211.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 31369.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46929.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16688.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46929.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 17551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24134.05 } ] } ] }, { "description": "27520 O CLOSED TX PATELLAR FRACTURE W/O MANIPULATION (RH)", "code_information": [ { "code": "27520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2353.5, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 2052.252, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "I-D PERIREC ABSCESS FAC", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.75, "discounted_cash": 1180.0, "minimum": 125.925, "maximum": 3862.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 399.75, "10th_percentile": 399.75, "90th_percentile": 399.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36904 FAC THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [ { "code": "36904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17716.25, "discounted_cash": 5615.0, "minimum": 5314.875, "maximum": 17716.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17716.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17716.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17716.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REM FB SHOULDER SUBQ FAC", "code_information": [ { "code": "23330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 650.75, "discounted_cash": 1629.0, "minimum": 195.225, "maximum": 650.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 650.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 16469.0, "minimum": 13526.36, "maximum": 48997.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 29850.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36640.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 29312.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48997.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13526.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16469.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48997.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16469.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22551.43 } ] } ] }, { "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": 8305.0, "minimum": 6360.7, "maximum": 20638.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14048.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17244.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13795.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20638.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6360.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8305.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20638.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8305.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10613.42 } ] } ] }, { "description": "EEG AWAKE/DROWSY", "code_information": [ { "code": "95816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 750.25, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 750.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 750.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 750.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 750.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 301.39, "10th_percentile": 301.39, "90th_percentile": 301.39, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 301.39, "10th_percentile": 301.39, "90th_percentile": 301.39, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Alpha Fetoprotein, Serum, Tumor Marker", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.25, "discounted_cash": 16.0, "minimum": 16.2971, "maximum": 192.058, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 38.81, "10th_percentile": 38.81, "90th_percentile": 148.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 36.79, "10th_percentile": 36.79, "90th_percentile": 140.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 148.16, "10th_percentile": 38.85, "90th_percentile": 151.0, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 57.75, "10th_percentile": 41.89, "90th_percentile": 74.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 50.82, "10th_percentile": 16.77, "90th_percentile": 193.82, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Liver+ Spleen Scan w Flow", "code_information": [ { "code": "78216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.5, "discounted_cash": 394.0, "minimum": 185.85, "maximum": 619.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 619.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 619.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 619.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 619.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 619.5, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "KOH, Fluor", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.5, "discounted_cash": 5.0, "minimum": 5.238, "maximum": 90.252, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Spleen Scan", "code_information": [ { "code": "78185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.5, "discounted_cash": 394.0, "minimum": 189.15, "maximum": 630.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 630.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 630.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 630.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 630.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Elbow Left Min 3 Views", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.75, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 95.79, "10th_percentile": 95.79, "90th_percentile": 95.97, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 354.2, "10th_percentile": 85.22, "90th_percentile": 372.13, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [ { "code": "207", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49986.0, "minimum": 44761.63, "maximum": 128380.8259, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 115572.19, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 50383.86, "10th_percentile": 50383.86, "90th_percentile": 50383.86, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 94728.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 116274.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 93019.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 112642.4, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 117750.1, "10th_percentile": 117750.1, "90th_percentile": 117750.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 127756.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44761.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49986.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 127757.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 49986.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71564.67 } ] } ] }, { "description": "36906 FAC THRMBC/NFS DIALYSIS CIRCUIT W TRANS STNT", "code_information": [ { "code": "36906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54273.0, "discounted_cash": 18087.0, "minimum": 16281.9, "maximum": 54273.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54273.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54273.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 54273.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "13160 FAC SCNDRY CLS COMPLX WND", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5024.75, "discounted_cash": 3496.0, "minimum": 1507.425, "maximum": 6776.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5024.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5024.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5024.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3811.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5024.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "54055 O DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION (RH)", "code_information": [ { "code": "54055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 827.25, "discounted_cash": 2035.0, "minimum": 248.175, "maximum": 827.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 827.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "C9774 FAC REVASC LITHOTR-ATHER TIB/PER", "code_information": [ { "code": "C9774", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56815.25, "discounted_cash": 18087.0, "minimum": 17044.575, "maximum": 56815.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56815.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56815.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56815.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Differential WBC", "code_information": [ { "code": "85004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.75, "discounted_cash": 6.0, "minimum": 6.2875, "maximum": 30.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 19.49, "10th_percentile": 19.49, "90th_percentile": 19.49, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "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": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "46080 O SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX (RH)", "code_information": [ { "code": "46080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1605.5, "discounted_cash": 2738.0, "minimum": 481.65, "maximum": 1605.5, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6455.74, "10th_percentile": 6455.74, "90th_percentile": 6455.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "26720 O CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA (RH)", "code_information": [ { "code": "26720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1527.75, "discounted_cash": 243.0, "minimum": 165.225, "maximum": 1332.198, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "0237T FAC TRLUML PERIO ATHRC BRCHIOCPH", "code_information": [ { "code": "0237T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53665.75, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 53665.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53665.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7967.0, "minimum": 6510.2, "maximum": 20186.1024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 13393.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16439.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13151.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12769.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6510.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12769.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7967.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10118.5 } ] } ] }, { "description": "Copper, Serum", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.0, "discounted_cash": 12.0, "minimum": 12.06, "maximum": 95.048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 73.25, "10th_percentile": 73.25, "90th_percentile": 73.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.32, "10th_percentile": 73.32, "90th_percentile": 229.5, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 55.47, "10th_percentile": 55.47, "90th_percentile": 55.47, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 95.05, "10th_percentile": 12.41, "90th_percentile": 95.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [ { "code": "922", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14352.0, "minimum": 11692.89, "maximum": 41262.6243, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 25753.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31611.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 25289.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25955.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11692.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25955.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19456.27 } ] } ] }, { "description": "Phonophoresis/15M OPRS OT", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 13.0, "minimum": 13.2845, "maximum": 94.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MA US BX L Axilla w wo Clip Specimen 385", "code_information": [ { "code": "38505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2513.0, "discounted_cash": 1629.0, "minimum": 216.825, "maximum": 2513.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1972.71, "10th_percentile": 1972.71, "90th_percentile": 1972.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2513.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2513.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2513.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2513.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "26010 O DRAINAGE FINGER ABSCESS SIMPLE (RH)", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1088.75, "discounted_cash": 197.0, "minimum": 92.475, "maximum": 949.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 779.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 947.43, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 757.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "21930 O EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM (RH)", "code_information": [ { "code": "21930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3165.5, "discounted_cash": 1629.0, "minimum": 949.65, "maximum": 3165.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3165.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3165.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3165.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "U Cyc AMP", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.75, "discounted_cash": 25.0, "minimum": 25.0724, "maximum": 278.822, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.07, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11642 O EXCISION MALIGNANT LES F/E/E/N/L 1.1-2.0 CM (RH)", "code_information": [ { "code": "11642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1633.25, "discounted_cash": 698.0, "minimum": 489.975, "maximum": 1633.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1633.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1633.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1633.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "822", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10204.0, "minimum": 7915.93, "maximum": 26540.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17724.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21756.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 17404.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26540.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7915.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26540.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13390.5 } ] } ] }, { "description": "TX ULNAR SHAFT FX FAC", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.25, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 1640.668, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "33233 FAC PACEMAKER REMOVAL", "code_information": [ { "code": "33233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6048.25, "discounted_cash": 8165.0, "minimum": 1814.475, "maximum": 6048.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Vital Capacity Total", "code_information": [ { "code": "94150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.5, "discounted_cash": 126.0, "minimum": 20.625, "maximum": 244.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 244.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 244.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 244.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COMPLEX NOSE 1.1-2.5 FAC", "code_information": [ { "code": "13151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1890.25, "discounted_cash": 729.0, "minimum": 567.075, "maximum": 2647.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1890.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1890.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1890.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "54065 O DSTRJ LESION PENIS EXTENSIVE (RH)", "code_information": [ { "code": "54065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1640.25, "discounted_cash": 2035.0, "minimum": 492.075, "maximum": 1640.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1640.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LARYNGO INDIR FB REM FAC", "code_information": [ { "code": "31511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.25, "discounted_cash": 196.0, "minimum": 54.975, "maximum": 183.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR TFESI L or S SPINE RIGHT 64483", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2944.75, "discounted_cash": 872.0, "minimum": 428.7, "maximum": 2944.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 815.75, "90th_percentile": 2992.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2944.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2944.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2944.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2257.45, "10th_percentile": 2257.45, "90th_percentile": 2257.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Ankle Arthro Left 73722", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2657.5, "discounted_cash": 773.0, "minimum": 773.49, "maximum": 2657.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 950.63, "10th_percentile": 950.63, "90th_percentile": 1004.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2657.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2657.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2657.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 2065.94, "10th_percentile": 2065.94, "90th_percentile": 2065.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2164.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2338.6, "10th_percentile": 2338.6, "90th_percentile": 2338.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Brain Imaging Complete w Vasc Flow", "code_information": [ { "code": "78606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 535.0, "minimum": 420.525, "maximum": 1401.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1401.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1401.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1401.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1401.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GLUCOSE BLD MNTR DV FAC", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 3.0, "minimum": 3.1875, "maximum": 26.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INS TUNLD CVAD W PORT >5YR FAC", "code_information": [ { "code": "36561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5973.5, "discounted_cash": 3115.0, "minimum": 1792.05, "maximum": 5973.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 4486.2, "10th_percentile": 4486.2, "90th_percentile": 4486.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5973.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5973.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5973.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 4622.28, "10th_percentile": 4622.28, "90th_percentile": 4622.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Obstetrical Complete 14- Wk", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 774.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 674.928, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 490.73, "10th_percentile": 490.73, "90th_percentile": 490.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 590.33, "10th_percentile": 567.7, "90th_percentile": 590.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 289.39, "10th_percentile": 275.53, "90th_percentile": 584.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 674.93, "10th_percentile": 296.68, "90th_percentile": 674.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Factor X Activity", "code_information": [ { "code": "85260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.75, "discounted_cash": 17.0, "minimum": 17.3952, "maximum": 286.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Doppler Veloc Fetal Mid Cerebral Art", "code_information": [ { "code": "76821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 413.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 413.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 413.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Abdomen 1 View 74018", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 321.75, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 321.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 242.8, "10th_percentile": 203.95, "90th_percentile": 242.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 321.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 321.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 321.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 203.99, "10th_percentile": 203.99, "90th_percentile": 203.99, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 235.94, "10th_percentile": 235.94, "90th_percentile": 245.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 190.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 242.8, "10th_percentile": 242.8, "90th_percentile": 242.8, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 267.08, "10th_percentile": 85.22, "90th_percentile": 280.57, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Facet Inj Lumbar Spine 64493", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2977.5, "discounted_cash": 872.0, "minimum": 303.975, "maximum": 2977.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 1995.15, "90th_percentile": 1995.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2977.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2977.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2977.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2992.72, "10th_percentile": 2992.72, "90th_percentile": 2992.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3523.07, "10th_percentile": 3523.07, "90th_percentile": 3523.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1887) CATHETER GUIDING", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 80.66, "10th_percentile": 80.66, "90th_percentile": 80.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 90.08, "10th_percentile": 49.83, "90th_percentile": 164.82, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 181.17, "10th_percentile": 181.17, "90th_percentile": 181.17, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 130.8, "10th_percentile": 122.1, "90th_percentile": 517.97, "count": "1 through 10" } ] } ] }, { "description": "IR Biliary Drain Cath Ext 47533", "code_information": [ { "code": "47533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13135.0, "discounted_cash": 3532.0, "minimum": 3532.78, "maximum": 13135.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13135.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13135.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13135.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Smoking Cessation greater than 10 Minutes", "code_information": [ { "code": "99407", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 36.0, "minimum": 28.2, "maximum": 105.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPINAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "030", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17743.0, "minimum": 15402.73, "maximum": 39666.9128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 32316.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39666.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 31733.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38717.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15402.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38717.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 17743.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24414.31 } ] } ] }, { "description": "56620 O VULVECTOMY SIM/PRTL (RH)", "code_information": [ { "code": "56620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4449.5, "discounted_cash": 3194.0, "minimum": 1334.85, "maximum": 4449.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4449.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3481.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4449.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4449.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4449.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14950.0, "minimum": 12584.36, "maximum": 44827.6325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 26910.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33031.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 26425.31 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 39208.76, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22345.08, "10th_percentile": 22345.08, "90th_percentile": 22345.08, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28278.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12584.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28278.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20330.43 } ] } ] }, { "description": "XR Arthro Inject Hip", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 755.25, "minimum": 226.575, "maximum": 658.578, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 598.16, "10th_percentile": 598.16, "90th_percentile": 598.16, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 587.13, "10th_percentile": 587.13, "90th_percentile": 587.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 664.62, "10th_percentile": 664.62, "90th_percentile": 664.62, "count": "1 through 10" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21629.0, "minimum": 18905.61, "maximum": 89036.5521, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 39839.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 48900.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 39120.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58526.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18905.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21629.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58526.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 21629.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30097.49 } ] } ] }, { "description": "Herpesvirus 6 DNA, QL RT PCR", "code_information": [ { "code": "87532", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 279.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR ESI Lumbar Spine 62323", "code_information": [ { "code": "62323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2805.25, "discounted_cash": 696.0, "minimum": 406.425, "maximum": 2805.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1849.59, "10th_percentile": 1849.59, "90th_percentile": 1849.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2805.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "92582 O CONDITIONING PLAY AUDIOMETRY (RH)", "code_information": [ { "code": "92582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.5, "discounted_cash": 126.0, "minimum": 78.15, "maximum": 260.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 260.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 260.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ULNAR SHAFT FX MANI FAC", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.25, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 323.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "46040 O I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX (RH)", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3862.5, "discounted_cash": 1180.0, "minimum": 125.925, "maximum": 3862.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3862.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3862.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3862.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1287.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1996.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36314.0, "minimum": 33562.91, "maximum": 106374.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 68263.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 83789.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 67031.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 106373.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33562.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36314.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 106374.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 36314.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51571.23 } ] } ] }, { "description": "INJ ASP SMALL JOINT FAC", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.5, "discounted_cash": 302.0, "minimum": 61.95, "maximum": 1518.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 943.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 943.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "29125 O APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC (RH)", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327.75, "discounted_cash": 131.0, "minimum": 85.65, "maximum": 327.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 182.78, "10th_percentile": 182.78, "90th_percentile": 182.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 327.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 327.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 224.12, "10th_percentile": 224.12, "90th_percentile": 224.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bill HIV GT Phenotype, additional", "code_information": [ { "code": "87904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.25, "discounted_cash": 26.0, "minimum": 25.3348, "maximum": 104.25, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.25 } ] } ] }, { "description": "Legionella pneumophila DFA", "code_information": [ { "code": "87278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.25, "discounted_cash": 15.0, "minimum": 15.1601, "maximum": 166.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1781) MESH", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 867.89, "10th_percentile": 867.89, "90th_percentile": 867.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 990.06, "10th_percentile": 990.06, "90th_percentile": 1751.11, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1196.54, "10th_percentile": 1196.54, "90th_percentile": 1196.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2464.22, "10th_percentile": 1912.68, "90th_percentile": 3578.52, "count": "1 through 10" } ] } ] }, { "description": "Protein, Body Fluid", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.0, "discounted_cash": 4.0, "minimum": 3.8872, "maximum": 70.632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.6, "10th_percentile": 51.6, "90th_percentile": 51.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 55.53, "10th_percentile": 55.53, "90th_percentile": 55.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.88, "10th_percentile": 17.88, "90th_percentile": 17.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Echo 3D Recon w Post Proc on WS", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 807.25, "minimum": 242.175, "maximum": 703.922, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 356.83 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6643.0, "minimum": 5116.94, "maximum": 20387.5574, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 18353.48, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12860.37, "10th_percentile": 12860.37, "90th_percentile": 12860.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 10830.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13293.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10635.18 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 17832.1, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18447.32, "10th_percentile": 18447.32, "90th_percentile": 18447.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 17888.21, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11914.91, "10th_percentile": 11914.91, "90th_percentile": 14587.72, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10476.26 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 20340.8, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8516.91, "10th_percentile": 8516.91, "90th_percentile": 8516.91, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5116.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6643.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10476.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 20387.56, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6038.94, "10th_percentile": 6038.94, "90th_percentile": 6413.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6643.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8182.22 } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 500 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "25021013282", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" } ] } ] }, { "description": "Lidocaine HCl Local Inj 2%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150025410", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "64634 O DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA (RH)", "code_information": [ { "code": "64634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1084.5, "minimum": 325.35, "maximum": 945.684, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2244.54, "10th_percentile": 2244.54, "90th_percentile": 2244.54, "count": "1 through 10" } ] } ] }, { "description": "CT Renal Cyst Aspiration Needle Inj", "code_information": [ { "code": "50390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1391.0, "discounted_cash": 698.0, "minimum": 417.3, "maximum": 1391.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1391.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1391.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1391.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SC Therapy Infusion Addl Hr", "code_information": [ { "code": "96370", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.5, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 213.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "19110 O NIPPLE EXPLORATION (RH)", "code_information": [ { "code": "19110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2935.25, "discounted_cash": 3863.0, "minimum": 880.575, "maximum": 2935.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2935.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CSF Glucose", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.0, "discounted_cash": 3.0, "minimum": 3.8192, "maximum": 49.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 36.31, "10th_percentile": 36.31, "90th_percentile": 36.31, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.08, "10th_percentile": 39.08, "90th_percentile": 39.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.57, "10th_percentile": 17.57, "90th_percentile": 17.57, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Pneumococcal 20-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00005200001", "type": "NDC" }, { "code": "90677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 477.525, "maximum": 1388.006, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1158.7, "10th_percentile": 1158.7, "90th_percentile": 1158.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 768.82, "10th_percentile": 738.86, "90th_percentile": 768.82, "count": "29" } ] } ] }, { "description": "APPLY SHOULDER HANDCAST FAC", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.25, "discounted_cash": 275.0, "minimum": 88.875, "maximum": 558.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 296.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 296.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 296.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 296.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM", "code_information": [ { "code": "173", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23684.0, "minimum": 21238.79, "maximum": 64369.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 43817.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 53783.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 43026.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 64369.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21238.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23684.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64369.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 23684.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33102.57 } ] } ] }, { "description": "EBV Nuclear Ab, IgG", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.5, "discounted_cash": 15.0, "minimum": 14.8588, "maximum": 157.396, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 136.2, "10th_percentile": 136.2, "90th_percentile": 136.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 114.98, "10th_percentile": 114.98, "90th_percentile": 114.98, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 68.35, "10th_percentile": 68.35, "90th_percentile": 68.35, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 149.82, "10th_percentile": 80.23, "90th_percentile": 157.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64493 O NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL (RH)", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1013.25, "discounted_cash": 872.0, "minimum": 303.975, "maximum": 2977.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 1995.15, "90th_percentile": 1995.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1013.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1013.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1013.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2992.72, "10th_percentile": 2992.72, "90th_percentile": 2992.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3523.07, "10th_percentile": 3523.07, "90th_percentile": 3523.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1013.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36593 DECLOT VASCLR DEV", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.0, "discounted_cash": 325.0, "minimum": 264.6, "maximum": 882.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 882.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 882.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 882.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 653.02, "10th_percentile": 653.02, "90th_percentile": 653.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 643.94, "10th_percentile": 643.94, "90th_percentile": 1287.89, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 321.02, "10th_percentile": 321.02, "90th_percentile": 321.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 250 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00143972201", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" } ] } ] }, { "description": "HB ASC TREAT METATARSAL FRACTURE ASC", "code_information": [ { "code": "28476", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Nephrostogram-Loopogram", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1163.25, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1163.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1163.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1163.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1163.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 985.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "90690 TYPHOID V LIVE/ORAL - AMB TYPHOID LIVE (RH)", "code_information": [ { "code": "90690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.0, "minimum": 31.8, "maximum": 106.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.0 } ] } ] }, { "description": "$ Hepatic Function Panel 80076", "code_information": [ { "code": "80076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.25, "discounted_cash": 8.0, "minimum": 7.9396, "maximum": 199.906, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 173.0, "10th_percentile": 36.52, "90th_percentile": 173.0, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 146.03, "10th_percentile": 137.75, "90th_percentile": 146.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 148.26, "10th_percentile": 148.26, "90th_percentile": 154.22, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 36.52, "10th_percentile": 36.52, "90th_percentile": 173.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 190.3, "10th_percentile": 8.17, "90th_percentile": 199.91, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Protein Total", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.5, "discounted_cash": 3.0, "minimum": 3.5665, "maximum": 65.836, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 50.74, "10th_percentile": 48.38, "90th_percentile": 60.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 48.09, "10th_percentile": 48.09, "90th_percentile": 48.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 48.43, "10th_percentile": 48.43, "90th_percentile": 51.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 16.4, "10th_percentile": 16.4, "90th_percentile": 60.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 63.36, "10th_percentile": 3.67, "90th_percentile": 66.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "21920 O BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL (RH)", "code_information": [ { "code": "21920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1705.75, "discounted_cash": 1629.0, "minimum": 511.725, "maximum": 1705.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1705.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1705.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1705.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1705.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1705.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Urine Microscopic", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.25, "discounted_cash": 3.0, "minimum": 2.964, "maximum": 43.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.7, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UNNABOOT FAC", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.75, "discounted_cash": 160.0, "minimum": 113.625, "maximum": 707.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 631.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 613.86, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "46221 O HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS (RH)", "code_information": [ { "code": "46221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1847.0, "discounted_cash": 917.0, "minimum": 554.1, "maximum": 1847.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1847.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1847.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1847.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1551.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC", "code_information": [ { "code": "640", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11205.0, "minimum": 9191.53, "maximum": 30288.4514, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 27266.55, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15515.53, "10th_percentile": 15515.53, "90th_percentile": 23451.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19662.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24134.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 19307.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22589.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9191.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11205.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22589.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11205.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14854.12 } ] } ] }, { "description": "HB ASC REPAIR GRAFT WRIST BONE ASC", "code_information": [ { "code": "25440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13194.25, "discounted_cash": 7159.0, "minimum": 3958.275, "maximum": 13194.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13194.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13194.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13194.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lorazepam Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "65219036801", "type": "NDC" }, { "code": "J2060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" } ] } ] }, { "description": "17261 O DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM (RH)", "code_information": [ { "code": "17261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603.25, "discounted_cash": 197.0, "minimum": 180.975, "maximum": 603.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 603.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 603.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 603.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DRAIN SHOULDER LESION FAC", "code_information": [ { "code": "23030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7096.25, "discounted_cash": 2866.0, "minimum": 2128.875, "maximum": 7096.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7096.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7096.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7096.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9988.0, "minimum": 7877.86, "maximum": 39936.3127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17305.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21241.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 16992.86 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 33982.5, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 30154.34, "10th_percentile": 30154.34, "90th_percentile": 30154.34, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32184.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7877.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9988.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32184.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 39936.31, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8895.07, "10th_percentile": 8895.07, "90th_percentile": 8895.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9988.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13073.53 } ] } ] }, { "description": "HB ASC EXC HAND LES SC > 1.5 CM ASC", "code_information": [ { "code": "26111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2027.0, "discounted_cash": 1629.0, "minimum": 608.1, "maximum": 3248.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 631.8, "10th_percentile": 631.8, "90th_percentile": 1486.58, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RPR CMPL T2.6-7.5 FAC", "code_information": [ { "code": "13101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1890.25, "discounted_cash": 729.0, "minimum": 567.075, "maximum": 2506.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1890.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1890.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1890.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "30MCG/0.3 ML 12yo AND UP PFIZER CVD-19 91320 - AMB SARS-CoV-2 (RH)", "code_information": [ { "code": "91320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.0, "minimum": 48.0, "maximum": 219.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 105.78, "10th_percentile": 105.78, "90th_percentile": 105.78, "count": "1 through 10" } ] } ] }, { "description": "43264 FAC IR ERCP STONE REM", "code_information": [ { "code": "43264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5721.25, "discounted_cash": 3804.0, "minimum": 1716.375, "maximum": 5721.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1153.08, "10th_percentile": 1153.08, "90th_percentile": 1153.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Brain wo Contrast", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1743.0, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1519.896, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1329.39, "10th_percentile": 1329.39, "90th_percentile": 1355.01, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1161.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 514.09, "10th_percentile": 514.09, "90th_percentile": 1380.46, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1140.23, "10th_percentile": 1140.23, "90th_percentile": 1140.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1171.3, "10th_percentile": 513.69, "90th_percentile": 1171.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "VL Duplex Scan Hemodialysis Access - Vascular US Charges", "code_information": [ { "code": "93990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 616.722, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 555.19, "10th_percentile": 555.19, "90th_percentile": 555.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 616.72, "10th_percentile": 616.72, "90th_percentile": 616.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "15788 O CHEMICAL PEEL FACIAL EPIDERMAL (RH)", "code_information": [ { "code": "15788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1837.25, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1837.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1837.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "45915 O RMVL FECAL IMPACTION/FB SPX UNDER ANES (RH)", "code_information": [ { "code": "45915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1781.75, "discounted_cash": 1180.0, "minimum": 104.55, "maximum": 1781.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 5511.24, "10th_percentile": 5511.24, "90th_percentile": 5511.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1781.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1781.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1781.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1287.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1781.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Bone Marrow Scan Limited", "code_information": [ { "code": "78102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.25, "discounted_cash": 394.0, "minimum": 196.275, "maximum": 654.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 654.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 654.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 654.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 654.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 654.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37766 O ST PHLBECTMY 21+ (RH)", "code_information": [ { "code": "37766", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3951.0, "discounted_cash": 3115.0, "minimum": 1185.3, "maximum": 3951.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3951.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3951.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3951.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3951.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INSERT CATH PLEURO W/O IMAGE", "code_information": [ { "code": "32556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2455.5, "discounted_cash": 1893.0, "minimum": 736.65, "maximum": 2455.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2455.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2455.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2455.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2063.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2455.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COLPORRHAPHY FAC", "code_information": [ { "code": "57200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7672.25, "discounted_cash": 3194.0, "minimum": 2301.675, "maximum": 7672.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7672.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7672.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7672.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3481.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5401.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PROSTATECTOMY WITH MCC", "code_information": [ { "code": "665", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24785.0, "minimum": 23765.08, "maximum": 67500.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 45948.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56399.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 45119.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 67500.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23765.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67500.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 24785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34712.99 } ] } ] }, { "description": "36254 FAC ANGIOGR RENAL 2ND + BIL", "code_information": [ { "code": "36254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7231.25, "discounted_cash": 3115.0, "minimum": 2169.375, "maximum": 7231.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 353.0, "minimum": 64.875, "maximum": 216.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11720 O DEBRIDEMENT NAIL ANY METHOD 1-5 (RH)", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.75, "discounted_cash": 58.0, "minimum": 20.325, "maximum": 112.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26170.0, "minimum": 18780.34, "maximum": 71440.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 48629.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 59690.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 47752.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71440.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18780.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26170.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71440.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 26170.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36738.25 } ] } ] }, { "description": "IR Remove Nephrostomy Tube w Fluoro S+I", "code_information": [ { "code": "50389", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2260.75, "discounted_cash": 688.0, "minimum": 678.225, "maximum": 2260.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2260.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2260.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2260.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1163.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ketorolac Tromethamine Inj 30 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00338007225", "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": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.27, "count": "39" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.27, "10th_percentile": 14.13, "90th_percentile": 14.84, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.64, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CCMCC", "code_information": [ { "code": "688", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7058.0, "minimum": 5012.43, "maximum": 17090.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11634.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14280.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 11424.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17090.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5012.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7058.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17090.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7058.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8789.46 } ] } ] }, { "description": "17004 O DESTRUCTION PREMALIGNANT LESION 15/> (RH)", "code_information": [ { "code": "17004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 561.25, "discounted_cash": 401.0, "minimum": 168.375, "maximum": 561.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 561.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 561.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 561.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 561.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11043 O DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< (RH)", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 893.25, "discounted_cash": 729.0, "minimum": 168.675, "maximum": 893.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 893.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 893.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 893.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 893.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "95115 F ALLERGEN IMMUNOTHER (RH)", "code_information": [ { "code": "95115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.75, "discounted_cash": 46.0, "minimum": 11.025, "maximum": 46.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Somatostatin Quantitative, Plasma", "code_information": [ { "code": "84307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 595.25, "discounted_cash": 18.0, "minimum": 17.7645, "maximum": 519.058, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Cholangiogram Injection 47531", "code_information": [ { "code": "47531", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1560.5, "discounted_cash": 3532.0, "minimum": 468.15, "maximum": 1560.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1560.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "27516 O CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ (RH)", "code_information": [ { "code": "27516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3801.0, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 3314.472, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "58322 O ART INSMNTN UTERN (RH)", "code_information": [ { "code": "58322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 582.0, "discounted_cash": 199.0, "minimum": 174.6, "maximum": 582.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 582.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 582.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 582.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MNT Group Each 30 Min", "code_information": [ { "code": "97804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.0, "discounted_cash": 11.0, "minimum": 11.6033, "maximum": 42.728, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Single View 2 Or More Joints", "code_information": [ { "code": "77077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.5, "discounted_cash": 103.0, "minimum": 93.75, "maximum": 312.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 312.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 312.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 312.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 269.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Renal Cryoablation", "code_information": [ { "code": "50593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15375.0, "discounted_cash": 10488.0, "minimum": 4612.5, "maximum": 15375.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15375.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15375.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15375.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11432.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15375.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "10160 O PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST (RH)", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 433.25, "discounted_cash": 401.0, "minimum": 98.475, "maximum": 433.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 433.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 433.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 433.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 433.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Nephrostogram w Access 50430", "code_information": [ { "code": "50430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1881.5, "discounted_cash": 688.0, "minimum": 564.45, "maximum": 1881.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1881.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1881.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1881.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1163.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITHOUT CCMCC", "code_information": [ { "code": "387", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6229.0, "minimum": 4639.37, "maximum": 19254.4105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 10029.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12310.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 9848.78 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 16840.98, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20377.28, "10th_percentile": 20377.28, "90th_percentile": 20377.28, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12284.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6229.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12284.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6229.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7577.2 } ] } ] }, { "description": "37212 FAC THROMBOLYSIS VEN INITL", "code_information": [ { "code": "37212", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2889.25, "discounted_cash": 3115.0, "minimum": 866.775, "maximum": 2889.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2889.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "zzU24 OHProl", "code_information": [ { "code": "83505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 383.75, "discounted_cash": 24.0, "minimum": 23.6147, "maximum": 334.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.52, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITHOUT CCMCC", "code_information": [ { "code": "550", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7695.0, "minimum": 5966.88, "maximum": 25155.5694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 12868.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15794.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 12635.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11933.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5966.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7695.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11933.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7695.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9721.46 } ] } ] }, { "description": "64600 O DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH (RH)", "code_information": [ { "code": "64600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1877.0, "discounted_cash": 872.0, "minimum": 563.1, "maximum": 1877.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1877.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1877.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1877.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [ { "code": "320", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19341.0, "minimum": 16021.49, "maximum": 52018.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 35409.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 43463.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 34770.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 52018.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16021.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19341.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52018.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 19341.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26750.98 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8887.0, "minimum": 7214.79, "maximum": 34523.4167, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15174.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18626.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14901.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16233.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7214.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16233.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 34523.42, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16824.14, "10th_percentile": 16824.14, "90th_percentile": 16824.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11464.23 } ] } ] }, { "description": "DEBRIDE SKIN SUBQ MUSC FAC", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.25, "discounted_cash": 729.0, "minimum": 168.675, "maximum": 893.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36251 FAC ANGIOGR RENAL 1ST OR UNI", "code_information": [ { "code": "36251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7231.25, "discounted_cash": 3115.0, "minimum": 2169.375, "maximum": 7231.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64446 O INJECTION ANES SCIATIC NERVE CONT INFUSION CATH (RH)", "code_information": [ { "code": "64446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1154.5, "discounted_cash": 872.0, "minimum": 346.35, "maximum": 1154.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1154.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1154.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1154.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1154.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "32555 O THORACENTESIS W/I (RH)", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1624.75, "discounted_cash": 618.0, "minimum": 487.425, "maximum": 2153.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1624.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1624.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1624.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13446.0, "minimum": 11515.02, "maximum": 33195.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 23999.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29457.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 23565.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33195.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11515.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33195.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18130.56 } ] } ] }, { "description": "64483 O NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL (RH)", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1429.0, "discounted_cash": 872.0, "minimum": 428.7, "maximum": 2944.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 815.75, "90th_percentile": 2992.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1429.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1429.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1429.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1429.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "56440 O MARSUPIALIZATION BARTHOLINS GLAND CYST (RH)", "code_information": [ { "code": "56440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1528.25, "discounted_cash": 3194.0, "minimum": 458.475, "maximum": 1528.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1528.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "92943 FAC DES REVASC CHRN OCCL 1VES MCR", "code_information": [ { "code": "C9607", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22348.75, "discounted_cash": 18087.0, "minimum": 6704.625, "maximum": 22348.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Acute Abdomen w PA Chest", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 771.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 672.312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 565.36, "10th_percentile": 565.36, "90th_percentile": 565.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 639.98, "10th_percentile": 102.92, "90th_percentile": 672.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Infusion Non Chemo >8 w/Pump", "code_information": [ { "code": "C8957", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 873.0, "discounted_cash": 209.0, "minimum": 209.87, "maximum": 873.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 826.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 873.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 803.53, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64447 O INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE (RH)", "code_information": [ { "code": "64447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.25, "discounted_cash": 696.0, "minimum": 185.775, "maximum": 1522.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 619.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FAC REPAIR EYELID WOUND", "code_information": [ { "code": "67930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7700.0, "discounted_cash": 2345.0, "minimum": 2310.0, "maximum": 7700.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7700.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2557.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3967.34, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7700.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7700.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MANIP INTER JNT FRCT FAC", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703.0, "discounted_cash": 1586.0, "minimum": 210.9, "maximum": 703.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Urine, Drug Panel 6 with Confirmation", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.5, "discounted_cash": 62.0, "minimum": 12.0, "maximum": 258.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 163.8, "10th_percentile": 154.0, "90th_percentile": 277.77, "count": "21" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 470.66, "10th_percentile": 470.66, "90th_percentile": 470.66, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 173.89, "10th_percentile": 99.58, "90th_percentile": 333.49, "count": "51" }, { "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": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 258.5, "10th_percentile": 195.0, "90th_percentile": 258.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 134.29, "10th_percentile": 134.29, "90th_percentile": 470.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 105.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Aspergillus galactomannan Ag, Serum", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.5, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 366.676, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Temporary Transcutaneous Pacing", "code_information": [ { "code": "92953", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1036.0, "discounted_cash": 652.0, "minimum": 310.8, "maximum": 1036.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1036.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1036.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1036.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1036.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR FINGER HAND TENDON PRIME OR SEC ASC", "code_information": [ { "code": "26426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Shoulder Left wo Contrast", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2134.75, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1861.502, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1434.55, "10th_percentile": 1293.43, "90th_percentile": 1434.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1628.17, "10th_percentile": 1628.17, "90th_percentile": 1659.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1272.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 565.19, "10th_percentile": 565.19, "90th_percentile": 565.19, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1636.5, "10th_percentile": 233.95, "90th_percentile": 1878.58, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR OF PRIMARY ANKLE LIGAMENT ASC", "code_information": [ { "code": "27696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14404.5, "discounted_cash": 7159.0, "minimum": 4321.35, "maximum": 14404.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14404.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14404.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14404.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rapid Identification for Anaerobes WrkSht", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.5, "discounted_cash": 8.0, "minimum": 7.8521, "maximum": 42.3974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 27.42, "10th_percentile": 27.42, "90th_percentile": 27.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 51.0, "minimum": 40.65, "maximum": 135.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 135.5, "10th_percentile": 135.5, "90th_percentile": 135.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 118.16, "10th_percentile": 118.16, "90th_percentile": 118.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93600 FAC EP HIS RECORDING", "code_information": [ { "code": "93600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2818.5, "discounted_cash": 7695.0, "minimum": 845.55, "maximum": 2818.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [ { "code": "020", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60893.0, "minimum": 55793.53, "maximum": 192604.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 115840.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 142187.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 113750.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 192603.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55793.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60893.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 192604.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 60893.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 87514.28 } ] } ] }, { "description": "Cardiac Rehab Phase II w/o tele", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.5, "discounted_cash": 127.0, "minimum": 32.55, "maximum": 108.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OT Prosthetic Management, Initial 15", "code_information": [ { "code": "97761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 38.0, "minimum": 35.4, "maximum": 102.896, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "43260 FAC IR ERCP", "code_information": [ { "code": "43260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5721.25, "discounted_cash": 3804.0, "minimum": 1716.375, "maximum": 5721.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5721.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Epinephrine HCl-NaCl IV Soln 4 MG/250ML-0.9% (16 MCG/ML)", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "42023031501", "type": "NDC" }, { "code": "J0171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 14.6, "10th_percentile": 14.6, "90th_percentile": 14.6, "count": "1 through 10" } ] } ] }, { "description": "28400 O CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION (RH)", "code_information": [ { "code": "28400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1834.75, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 1599.902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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", "minimum": 1.0, "maximum": 3.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "40" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 4.45, "90th_percentile": 14.84, "count": "24" } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [ { "code": "811", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11728.0, "minimum": 9737.62, "maximum": 29579.7977, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 20673.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25375.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 20300.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23725.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9737.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11728.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23725.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11728.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15618.18 } ] } ] }, { "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": 235.0, "minimum": 235.42, "maximum": 1600.338, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1311.34, "10th_percentile": 233.95, "90th_percentile": 1440.67, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1225.18, "10th_percentile": 1041.4, "90th_percentile": 1399.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1327.18, "10th_percentile": 1208.16, "90th_percentile": 1406.9, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1386.88, "10th_percentile": 233.95, "90th_percentile": 1600.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "29425 O APPLICATION SHORT LEG CAST WALKING/AMBULATORY (RH)", "code_information": [ { "code": "29425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 514.0, "discounted_cash": 275.0, "minimum": 154.2, "maximum": 514.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 514.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 514.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 514.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Plasminogen Activator Inhib.1, Activity", "code_information": [ { "code": "85415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.0, "discounted_cash": 17.0, "minimum": 16.7052, "maximum": 168.296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.88, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [ { "code": "196", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15400.0, "minimum": 13040.48, "maximum": 34101.402, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 27782.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34101.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 27281.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28632.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13040.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15400.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28632.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 15400.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20988.83 } ] } ] }, { "description": "Surfactant Administration Newborn", "code_information": [ { "code": "94610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.5, "discounted_cash": 216.0, "minimum": 32.25, "maximum": 107.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med CONTRACT RATE Left Wrist Splint", "code_information": [ { "code": "L3908", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.5, "discounted_cash": 89.0, "minimum": 6.75, "maximum": 22.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64416 O INJECTION ANES BRACHIAL PLEXUS CONT NFS CATH (RH)", "code_information": [ { "code": "64416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1180.5, "discounted_cash": 872.0, "minimum": 354.15, "maximum": 1180.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1180.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1180.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1180.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1180.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC TREAT FX RAD EXTRA ARTICUL W INT FIX ASC", "code_information": [ { "code": "25607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13510.25, "discounted_cash": 7159.0, "minimum": 4053.075, "maximum": 13510.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13510.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13510.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13510.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "33217 FAC INSRTN DUAL LEAD PACEMKR", "code_information": [ { "code": "33217", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13123.75, "discounted_cash": 8165.0, "minimum": 3937.125, "maximum": 13123.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13123.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13123.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13123.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13123.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bill Parasite Conc", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.5, "discounted_cash": 6.0, "minimum": 6.4916, "maximum": 72.812, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 53.99, "10th_percentile": 53.99, "90th_percentile": 53.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 34.94, "10th_percentile": 34.94, "90th_percentile": 34.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REPAIR MOUTH LACERATION FAC", "code_information": [ { "code": "40831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3213.25, "discounted_cash": 532.0, "minimum": 532.15, "maximum": 2801.954, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2096.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2546.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2037.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "31525 O LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN (RH)", "code_information": [ { "code": "31525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1632.75, "discounted_cash": 1756.0, "minimum": 275.175, "maximum": 1632.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1632.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CL TRMT ACETABULUM FAC", "code_information": [ { "code": "27220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 804.0, "discounted_cash": 243.0, "minimum": 241.2, "maximum": 804.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 804.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 804.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 804.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [ { "code": "372", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8813.0, "minimum": 7124.12, "maximum": 21848.6633, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15030.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18449.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14759.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15222.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7124.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15222.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 21848.66, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8102.47, "10th_percentile": 8102.47, "90th_percentile": 8102.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8813.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11355.24 } ] } ] }, { "description": "IR Replace Cath of CVAD w Port", "code_information": [ { "code": "36578", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1236.75, "discounted_cash": 3115.0, "minimum": 371.025, "maximum": 1236.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC EXC HAND TUM DEEP > 1.5 CM ASC", "code_information": [ { "code": "26113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2027.0, "discounted_cash": 1629.0, "minimum": 608.1, "maximum": 2027.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Breast Bilat Post Clip 77047", "code_information": [ { "code": "77047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 988.25, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 988.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 588.39, "10th_percentile": 588.39, "90th_percentile": 588.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 988.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INHALATION ADMIN - AMB INH (RH)", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.25, "discounted_cash": 216.0, "minimum": 21.375, "maximum": 83.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITHOUT CCMCC", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12722.0, "minimum": 10624.93, "maximum": 44408.4172, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22597.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27737.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 22189.75 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 38842.09, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 38652.97, "10th_percentile": 38652.97, "90th_percentile": 38652.97, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30029.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10624.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12722.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30029.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12722.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17071.78 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7762.0, "minimum": 6106.0, "maximum": 21956.2665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 12996.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15952.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 12761.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 19264.61, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18375.29, "10th_percentile": 18375.29, "90th_percentile": 18375.29, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6106.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7762.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7762.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9818.22 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12279.0, "minimum": 10173.66, "maximum": 26685.5397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 21740.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26685.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21348.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17001.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10173.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12279.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17001.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12279.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16424.5 } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 100 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00075062300", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "Blood Urea Nitrogen", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.25, "discounted_cash": 3.0, "minimum": 3.8386, "maximum": 50.794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 46.6, "10th_percentile": 39.14, "90th_percentile": 46.6, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 37.11, "10th_percentile": 37.11, "90th_percentile": 37.11, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.94, "10th_percentile": 39.18, "90th_percentile": 39.94, "count": "16" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.66, "10th_percentile": 17.66, "90th_percentile": 39.14, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 50.79, "10th_percentile": 3.95, "90th_percentile": 51.26, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PCB Panel, Congers, Serum/Plasma", "code_information": [ { "code": "82441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.25, "discounted_cash": 6.0, "minimum": 5.8405, "maximum": 184.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "15115 O EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/< (RH)", "code_information": [ { "code": "15115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5754.25, "discounted_cash": 2035.0, "minimum": 1726.275, "maximum": 5754.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5754.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5754.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5754.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BD DXA Bone Density Appendclr", "code_information": [ { "code": "77081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.25, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 307.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 307.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 307.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 89.4, "10th_percentile": 89.4, "90th_percentile": 89.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 235.54, "10th_percentile": 85.22, "90th_percentile": 256.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIM REP FACE <2.5 FAC", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 197.0, "minimum": 119.4, "maximum": 435.25, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 347.06, "10th_percentile": 347.06, "90th_percentile": 347.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 300.17, "10th_percentile": 300.17, "90th_percentile": 300.17, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 398.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 398.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 294.63, "10th_percentile": 294.63, "90th_percentile": 294.63, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "12044 O REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM (RH)", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2084.5, "discounted_cash": 729.0, "minimum": 167.625, "maximum": 2084.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2084.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2084.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2084.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "41005 O DRAINAGE OF MOUTH LSN SUBLIN SUP (RH)", "code_information": [ { "code": "41005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1299.25, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1132.946, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FAC SHAVING SKIN LESION 0.5 CM/<", "code_information": [ { "code": "11305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 494.25, "discounted_cash": 197.0, "minimum": 65.55, "maximum": 494.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 494.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 494.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 494.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "URETHRAL STRICTURE", "code_information": [ { "code": "697", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9245.0, "minimum": 6733.07, "maximum": 23310.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15866.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19475.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 15580.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23310.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6733.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23310.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11986.95 } ] } ] }, { "description": "92990 FAC VALVUOPLASTY PULM VALVE B", "code_information": [ { "code": "92990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17756.25, "discounted_cash": 11390.0, "minimum": 5326.875, "maximum": 17756.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17756.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17756.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17756.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17756.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25012.0, "minimum": 22114.34, "maximum": 110733.4719, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 46387.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56938.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 45550.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 80460.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22114.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25012.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 80460.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 110733.47, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 103056.12, "10th_percentile": 103056.12, "90th_percentile": 103056.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 25012.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35044.41 } ] } ] }, { "description": "56820 O COLPOSCOPY VULVA (RH)", "code_information": [ { "code": "56820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556.5, "discounted_cash": 199.0, "minimum": 166.95, "maximum": 556.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 556.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 556.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 556.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LOW LEG FRCT MANIP FAC", "code_information": [ { "code": "27825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.5, "discounted_cash": 1586.0, "minimum": 201.45, "maximum": 671.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 506.48, "10th_percentile": 506.48, "90th_percentile": 506.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 671.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OT Eval Mod Complex", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.5, "discounted_cash": 96.0, "minimum": 93.7981, "maximum": 437.308, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 337.01, "10th_percentile": 337.01, "90th_percentile": 337.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 384.45, "10th_percentile": 384.45, "90th_percentile": 384.45, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 95.84, "10th_percentile": 95.84, "90th_percentile": 95.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Phenytoin Level", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.75, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 139.302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.23, "10th_percentile": 59.23, "90th_percentile": 59.23, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 13.25, "10th_percentile": 13.25, "90th_percentile": 13.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Pelvis w Contrast", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1939.5, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1691.244, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1479.26, "10th_percentile": 1479.26, "90th_percentile": 1479.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1585.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1402.69, "10th_percentile": 1402.69, "90th_percentile": 1402.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 694.95, "10th_percentile": 694.95, "90th_percentile": 694.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "58661 H LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES (RH)", "code_information": [ { "code": "58661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.75, "discounted_cash": 5965.0, "minimum": 647.925, "maximum": 2159.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6060.4, "10th_percentile": 6060.4, "90th_percentile": 7305.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 10347.09, "10th_percentile": 10347.09, "90th_percentile": 10347.09, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2159.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 6.0, "minimum": 6.2973, "maximum": 107.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 78.83, "10th_percentile": 78.83, "90th_percentile": 78.83, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 83.25, "10th_percentile": 83.25, "90th_percentile": 84.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 108.9, "10th_percentile": 34.0, "90th_percentile": 108.9, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Mycoplasma pneumoniae IgG", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.0, "discounted_cash": 13.0, "minimum": 12.8666, "maximum": 211.896, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "96160 O PT-FOCUSED HLTH RISK ASSMT (RH)", "code_information": [ { "code": "96160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.75, "discounted_cash": 36.0, "minimum": 4.5, "maximum": 99.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 99.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "53899 O UNLISTED PROCEDURE URINARY SYSTEM (RH)", "code_information": [ { "code": "53899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.0, "discounted_cash": 246.0, "minimum": 193.8, "maximum": 646.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 646.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 646.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 646.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SO KRAS Mutation Detect2", "code_information": [ { "code": "81276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 791.5, "discounted_cash": 193.0, "minimum": 187.8004, "maximum": 791.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 234.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 791.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 210.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 326.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TX RADIAL HEAD NK FX FAC", "code_information": [ { "code": "24650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.25, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 1668.572, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Angio Neck w+wo Contrast", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2458.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2380.9996, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 2381.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "40820 O DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS (RH)", "code_information": [ { "code": "40820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1608.25, "discounted_cash": 3271.0, "minimum": 482.475, "maximum": 1608.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1608.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FAC ASP BLADDER BY NEEDLE", "code_information": [ { "code": "51100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1080.75, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1080.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1080.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11760 O REPAIR NAIL BED (RH)", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 946.25, "discounted_cash": 729.0, "minimum": 109.05, "maximum": 946.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 946.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 946.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 946.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 946.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "3.6 MG ZOLADEX J9202 - AMB GOSERELIN (RH)", "code_information": [ { "code": "J9202", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1873.75, "discounted_cash": 777.0, "minimum": 562.125, "maximum": 1873.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1873.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1873.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1873.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1854.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 777.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 777.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 777.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1314.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Entire Lower Extrem RT WO Contrast", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1512.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1099.9, "10th_percentile": 1018.42, "90th_percentile": 1929.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1225.28, "10th_percentile": 1178.15, "90th_percentile": 2321.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 336.23, "10th_percentile": 336.23, "90th_percentile": 336.23, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1327.29, "10th_percentile": 102.92, "90th_percentile": 1512.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CCMCC", "code_information": [ { "code": "060", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8043.0, "minimum": 6176.59, "maximum": 33976.9917, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 13540.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16620.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13296.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 28911.61, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9430.33, "10th_percentile": 9430.33, "90th_percentile": 9430.33, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19645.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6176.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8043.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19645.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8043.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10229.72 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17313.0, "minimum": 14613.7, "maximum": 45569.7381, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 31484.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38645.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 30916.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38442.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14613.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17313.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38442.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 17313.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23785.94 } ] } ] }, { "description": "Voriconazole Level", "code_information": [ { "code": "80285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.0, "discounted_cash": 27.0, "minimum": 26.3455, "maximum": 209.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "92933 FAC DES ATHERECTMY W/STNT SNG MCR", "code_information": [ { "code": "C9602", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22348.75, "discounted_cash": 18087.0, "minimum": 6704.625, "maximum": 22348.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "29445 O APPLY RIGID TOT CONTCT CAST LEG (RH)", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.25, "discounted_cash": 275.0, "minimum": 156.975, "maximum": 523.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 523.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 523.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 523.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TREAT THIGH FRACTURE CLOSED W/WO SKIN FAC", "code_information": [ { "code": "27240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4801.5, "discounted_cash": 1586.0, "minimum": 1440.45, "maximum": 4801.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4801.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4801.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Infant Hips Dynamic", "code_information": [ { "code": "76885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.5, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 359.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 359.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 359.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.5, "discounted_cash": 12.0, "minimum": 12.4002, "maximum": 154.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 113.07, "10th_percentile": 113.07, "90th_percentile": 113.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 119.4, "10th_percentile": 119.4, "90th_percentile": 121.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 66.73, "10th_percentile": 12.76, "90th_percentile": 154.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [ { "code": "674", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18834.0, "minimum": 15977.2, "maximum": 97362.0128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 34427.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 42258.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 33806.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43913.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15977.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18834.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43913.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 18834.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26009.16 } ] } ] }, { "description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [ { "code": "176", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7170.0, "minimum": 5637.42, "maximum": 22878.5356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 20595.93, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 19333.37, "10th_percentile": 19333.37, "90th_percentile": 19333.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11850.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14546.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 11636.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 20073.82, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 48454.85, "10th_percentile": 48454.85, "90th_percentile": 48454.85, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12944.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5637.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7170.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12944.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 22878.54, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6574.03, "10th_percentile": 6574.03, "90th_percentile": 6574.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7170.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8952.95 } ] } ] }, { "description": "86486 O UNLISTED ANTIGEN EA (RH)", "code_information": [ { "code": "86486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 28.0, "minimum": 9.3, "maximum": 31.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "96413 O CHEMO IV INFUS 0-1H (RH)", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.75, "discounted_cash": 325.0, "minimum": 118.125, "maximum": 1159.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 741.89, "10th_percentile": 741.89, "90th_percentile": 741.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 11740.27, "10th_percentile": 1206.27, "90th_percentile": 22680.11, "count": "15" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 846.33, "10th_percentile": 846.33, "90th_percentile": 846.33, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 910.01, "10th_percentile": 234.87, "90th_percentile": 910.01, "count": "27" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 846.33, "10th_percentile": 128.41, "90th_percentile": 1010.87, "count": "77" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VL Injection Sclerosing Soln Single Vein - Vascular US Charges", "code_information": [ { "code": "36470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.5, "discounted_cash": 401.0, "minimum": 108.15, "maximum": 627.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Trichinella IgG Ab", "code_information": [ { "code": "86784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 12.0, "minimum": 12.2058, "maximum": 138.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rad Ther Cont Med Rad Physics Consult", "code_information": [ { "code": "77336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 678.75, "discounted_cash": 132.0, "minimum": 132.62, "maximum": 634.6795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 522.47, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 634.68, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 507.76, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "50MCG/0.5ML 12yo AND UP MODERNA CVD-19 91322 - AMB SARS-CoV-2 (RH)", "code_information": [ { "code": "91322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.75, "minimum": 73.125, "maximum": 243.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 243.75 } ] } ] }, { "description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [ { "code": "029", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26994.0, "minimum": 23232.83, "maximum": 61647.0661, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 50223.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 61647.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 49317.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51617.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23232.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26994.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51617.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 26994.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37942.72 } ] } ] }, { "description": "US Doppler Veloc Fetal Umbilical Art", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 413.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 413.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64418 O INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE (RH)", "code_information": [ { "code": "64418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 554.25, "discounted_cash": 696.0, "minimum": 166.275, "maximum": 554.25, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.25, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR FOREARM TENDON MUSCLE ASC", "code_information": [ { "code": "25270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "695", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9747.0, "minimum": 7805.88, "maximum": 24736.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 16838.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20668.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 16534.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24736.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7805.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9747.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24736.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9747.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12720.98 } ] } ] }, { "description": "XR Enema Barium", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 321.25, "discounted_cash": 173.0, "minimum": 96.375, "maximum": 321.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 321.25, "10th_percentile": 321.25, "90th_percentile": 321.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 321.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 321.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 321.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 321.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 172.29, "10th_percentile": 172.29, "90th_percentile": 172.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "62273 O INJECTION EPIDURAL BLOOD/CLOT PATCH (RH)", "code_information": [ { "code": "62273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 981.0, "discounted_cash": 696.0, "minimum": 294.3, "maximum": 2385.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 981.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 981.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 981.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 981.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "$ Thyroglobulin by CIA", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.0, "discounted_cash": 16.0, "minimum": 15.6071, "maximum": 203.176, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 186.4, "10th_percentile": 186.4, "90th_percentile": 186.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 159.74, "10th_percentile": 159.74, "90th_percentile": 159.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.06, "10th_percentile": 16.06, "90th_percentile": 205.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Surgical Specimen Breast", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.5, "discounted_cash": 539.0, "minimum": 64.65, "maximum": 215.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 66.19, "10th_percentile": 66.19, "90th_percentile": 66.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 75.13, "10th_percentile": 65.08, "90th_percentile": 76.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 98.5, "10th_percentile": 98.5, "90th_percentile": 98.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 85.89, "10th_percentile": 85.89, "90th_percentile": 85.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 215.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 1764.0, "minimum": 1764.27, "maximum": 8993.372, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1764.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6950.52, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8443.27, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1764.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6754.86, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1764.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1764.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1923.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1764.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1764.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1764.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1764.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1764.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2983.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [ { "code": "689", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9872.0, "minimum": 8100.03, "maximum": 25461.4926, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17081.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20966.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 16773.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20804.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8100.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20804.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 25461.49, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9123.97, "10th_percentile": 9123.97, "90th_percentile": 9123.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9872.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12904.49 } ] } ] }, { "description": "SO EGFR Mutation", "code_information": [ { "code": "81235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2102.5, "discounted_cash": 324.0, "minimum": 315.4268, "maximum": 1833.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 394.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 315.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1703.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 548.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Sodium Level", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 4.0, "minimum": 4.6744, "maximum": 32.918, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 4.81, "10th_percentile": 4.81, "90th_percentile": 32.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.37, "10th_percentile": 25.37, "90th_percentile": 30.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 24.05, "10th_percentile": 24.05, "90th_percentile": 24.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 25.88, "10th_percentile": 25.88, "90th_percentile": 25.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "$ Complete Blood Count with Differential 85025", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.25, "discounted_cash": 7.0, "minimum": 7.5509, "maximum": 82.186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 71.2, "10th_percentile": 59.81, "90th_percentile": 71.2, "count": "234" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 9.44, "10th_percentile": 9.44, "90th_percentile": 9.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 60.04, "10th_percentile": 56.69, "90th_percentile": 82.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 34.73, "10th_percentile": 17.97, "90th_percentile": 71.2, "count": "132" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 78.32, "10th_percentile": 40.77, "90th_percentile": 82.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Bone Length Study", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 735.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 650.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 283.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITHOUT CCMCC", "code_information": [ { "code": "053", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8495.0, "minimum": 6377.31, "maximum": 17693.9873, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14415.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17693.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14155.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16660.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6377.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8495.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16660.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8495.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10890.35 } ] } ] }, { "description": "24073 O EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/> (RH)", "code_information": [ { "code": "24073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4529.75, "discounted_cash": 2866.0, "minimum": 1358.925, "maximum": 4529.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4529.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4529.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4529.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4529.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64448 O INJECTION ANES FEMORAL NERVE CONT INFUSION CATH (RH)", "code_information": [ { "code": "64448", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1049.0, "discounted_cash": 872.0, "minimum": 314.7, "maximum": 1049.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1049.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1049.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1049.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1049.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "N-Telopeptide Cross-Linked, Urine", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.5, "discounted_cash": 18.0, "minimum": 18.1532, "maximum": 218.436, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 18.68, "10th_percentile": 18.68, "90th_percentile": 18.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med PSA (Prostate Specific Antigen)", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 18.0, "minimum": 15.0, "maximum": 180.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 148.0, "10th_percentile": 148.0, "90th_percentile": 148.0, "count": "40" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 22.34, "10th_percentile": 22.34, "90th_percentile": 22.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 35.18, "10th_percentile": 35.18, "90th_percentile": 117.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 124.45, "10th_percentile": 124.45, "90th_percentile": 126.84, "count": "87" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 82.2, "10th_percentile": 82.2, "90th_percentile": 148.0, "count": "30" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 96.5, "10th_percentile": 96.5, "90th_percentile": 96.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14598.0, "minimum": 12108.17, "maximum": 52983.6278, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 26229.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32195.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 25756.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36549.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12108.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36549.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 52983.63, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13226.47, "10th_percentile": 13226.47, "90th_percentile": 13226.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19815.5 } ] } ] }, { "description": "88173 AP Bill FNA Interp and report", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.25, "discounted_cash": 51.0, "minimum": 42.375, "maximum": 141.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 141.25, "10th_percentile": 141.25, "90th_percentile": 141.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 141.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 96.84, "10th_percentile": 96.84, "90th_percentile": 285.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 28.51, "10th_percentile": 28.51, "90th_percentile": 141.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 124.3, "10th_percentile": 124.3, "90th_percentile": 248.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Tetanus Ab, IgG", "code_information": [ { "code": "86774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.75, "discounted_cash": 14.0, "minimum": 14.3826, "maximum": 150.638, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 143.44, "10th_percentile": 143.44, "90th_percentile": 143.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "40652 O RPR LIP <= HALF (RH)", "code_information": [ { "code": "40652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3409.5, "discounted_cash": 532.0, "minimum": 532.15, "maximum": 2973.084, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2096.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2546.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2037.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93503 FAC INSERT SWAN GANZ", "code_information": [ { "code": "93503", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4555.0, "discounted_cash": 1553.0, "minimum": 1366.5, "maximum": 4555.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4555.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4555.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4555.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "757", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11938.0, "minimum": 9795.76, "maximum": 115265.0322, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 21079.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25874.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 20699.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26622.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9795.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11938.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26622.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11938.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15925.13 } ] } ] }, { "description": "Removal Subq Car Rhythm Monitor", "code_information": [ { "code": "33286", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.25, "discounted_cash": 698.0, "minimum": 670.875, "maximum": 2236.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2236.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2236.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Wrist Right AP+Lateral", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.5, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 347.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 347.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 266.39, "10th_percentile": 266.39, "90th_percentile": 266.39, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93005 F EKG TRACING ONLY (RH)", "code_information": [ { "code": "93005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 58.0, "minimum": 47.625, "maximum": 158.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 142.97, "10th_percentile": 142.97, "90th_percentile": 170.2, "count": "29" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 158.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 158.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 170.52, "10th_percentile": 170.52, "90th_percentile": 194.89, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 170.46, "10th_percentile": 165.39, "90th_percentile": 170.46, "count": "98" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 163.09, "10th_percentile": 163.09, "90th_percentile": 1956.33, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 168.5, "10th_percentile": 142.97, "90th_percentile": 175.45, "count": "32" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 187.22, "10th_percentile": 163.09, "90th_percentile": 194.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hepatitis B Core Antibody, IgM", "code_information": [ { "code": "86705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.25, "discounted_cash": 11.0, "minimum": 11.4381, "maximum": 100.498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 52.61, "10th_percentile": 52.61, "90th_percentile": 52.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 138.54, "10th_percentile": 138.54, "90th_percentile": 138.54, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 77.53, "10th_percentile": 74.56, "90th_percentile": 77.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 95.7, "10th_percentile": 11.77, "90th_percentile": 100.5, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Work Condition Initial 2 Hours OT", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.5, "minimum": 95.0, "maximum": 394.58, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13593.0, "minimum": 11184.18, "maximum": 29806.2011, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25792.23, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21480.93, "10th_percentile": 21480.93, "90th_percentile": 21480.93, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 24283.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29806.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 23844.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 25138.39, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 23516.5, "10th_percentile": 23516.5, "90th_percentile": 23516.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11184.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13593.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13593.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18345.21 } ] } ] }, { "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": 25081.0, "minimum": 21344.0, "maximum": 78333.7103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 46520.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57100.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 45680.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47935.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21344.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25081.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47935.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 25081.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35144.51 } ] } ] }, { "description": "XR Nephrostogram or Ureterogram 50431", "code_information": [ { "code": "50431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1881.5, "discounted_cash": 688.0, "minimum": 564.45, "maximum": 1881.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1881.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1881.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1881.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1163.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR UGI Double Contrast 74246", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.75, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 851.1666, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 712.2, "10th_percentile": 712.2, "90th_percentile": 712.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 598.34, "10th_percentile": 598.34, "90th_percentile": 598.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 851.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 172.29, "10th_percentile": 172.29, "90th_percentile": 822.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Triiodothyronine, Free (T3)", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.5, "discounted_cash": 16.0, "minimum": 16.4623, "maximum": 153.908, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 141.2, "10th_percentile": 118.61, "90th_percentile": 141.2, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 112.43, "10th_percentile": 112.43, "90th_percentile": 224.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 121.01, "10th_percentile": 118.73, "90th_percentile": 121.01, "count": "15" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 75.72, "10th_percentile": 75.72, "90th_percentile": 75.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 153.91, "10th_percentile": 153.91, "90th_percentile": 153.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11104 O PUNCH BX SKIN 1ST LESION (RH)", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.0, "discounted_cash": 401.0, "minimum": 107.4, "maximum": 919.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11011 O DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC (RH)", "code_information": [ { "code": "11011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1868.5, "discounted_cash": 698.0, "minimum": 324.975, "maximum": 1868.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1868.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1868.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1868.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Electroencephalogram Extnd Mntr >1 Hr", "code_information": [ { "code": "95813", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 908.5, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1466.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 908.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Biliary DrainCath Int Ext 47534", "code_information": [ { "code": "47534", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9851.25, "discounted_cash": 3532.0, "minimum": 2955.375, "maximum": 9851.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9851.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9851.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9851.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "N-STATE 90746 HEP B VAC ADLT IM - AMB HepB Adult (RH)", "code_information": [ { "code": "90746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.0, "minimum": 131.7, "maximum": 382.808, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 212.04, "10th_percentile": 212.04, "90th_percentile": 212.04, "count": "1 through 10" } ] } ] }, { "description": "Triiodothyronine, Total (T3)", "code_information": [ { "code": "84480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.5, "discounted_cash": 14.0, "minimum": 13.7801, "maximum": 135.596, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 124.4, "10th_percentile": 104.5, "90th_percentile": 124.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.22, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 99.05, "10th_percentile": 14.15, "90th_percentile": 99.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 104.6, "10th_percentile": 104.6, "90th_percentile": 106.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 124.4, "10th_percentile": 63.38, "90th_percentile": 124.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 135.6, "10th_percentile": 14.18, "90th_percentile": 136.84, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DEBRIDE SKIN SUBQ FAC", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 473.25, "discounted_cash": 401.0, "minimum": 95.1, "maximum": 614.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 473.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 473.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 473.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 473.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "14301 O ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM (RH)", "code_information": [ { "code": "14301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7427.5, "discounted_cash": 3496.0, "minimum": 2228.25, "maximum": 7427.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7427.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7427.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7427.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3811.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5913.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HCV Genosure", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1081.25, "discounted_cash": 130.0, "minimum": 126.6741, "maximum": 942.85, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 126.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" } ] } ] }, { "description": "NM Tumor Imaging WB Multi", "code_information": [ { "code": "78804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2264.5, "discounted_cash": 535.0, "minimum": 535.74, "maximum": 2264.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2110.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2264.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2051.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2264.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "100 MG INJ, PYRIDOXINE HCl VIT B6 J3415 - AMB PYRIDOXINE (RH)", "code_information": [ { "code": "J3415", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "minimum": 27.0255, "maximum": 96.792, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.03 } ] } ] }, { "description": "HB ASC REMOVAL OF FINGER LESION ASC", "code_information": [ { "code": "26210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2430.75, "discounted_cash": 1586.0, "minimum": 729.225, "maximum": 3451.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "N-STATE 90734 MENINGOCOCCAL CONJ VACCINE TETRAVALENT IM - AMB Mening Conj (RH)", "code_information": [ { "code": "90734", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 683.75, "minimum": 205.125, "maximum": 596.23, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.41 } ] } ] }, { "description": "56501 O DESTRUCTION LESIONS VULVA SIMPLE (RH)", "code_information": [ { "code": "56501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1112.25, "discounted_cash": 2035.0, "minimum": 333.675, "maximum": 1112.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1112.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10811.0, "minimum": 9030.95, "maximum": 28178.088, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25366.74, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22181.08, "10th_percentile": 19124.61, "90th_percentile": 44263.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 18899.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23198.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 18558.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19785.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9030.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10811.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19785.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28178.09, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 10410.18, "10th_percentile": 10062.84, "90th_percentile": 24981.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10811.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14278.01 } ] } ] }, { "description": "URETHRAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "671", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14699.0, "minimum": 11930.3, "maximum": 38818.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 26425.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32435.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 25948.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38818.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11930.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38818.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14699.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19963.42 } ] } ] }, { "description": "Protein C Antigen", "code_information": [ { "code": "85302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.75, "discounted_cash": 12.0, "minimum": 11.6713, "maximum": 63.0189, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93452 FAC LEFT HRT CATH W/VNTCGRPHY", "code_information": [ { "code": "93452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12945.5, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 12945.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12945.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRMT KNEE FRACTURE FAC", "code_information": [ { "code": "27532", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703.0, "discounted_cash": 3228.0, "minimum": 210.9, "maximum": 703.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [ { "code": "867", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16967.0, "minimum": 14841.41, "maximum": 45511.1842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 30815.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37823.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 30259.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39181.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14841.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16967.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39181.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16967.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23279.9 } ] } ] }, { "description": "Hydromorphone HCl-NaCl Soln Pref Syr 10 MG/50ML-0.9%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "09999401062", "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": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "31611 O CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH (RH)", "code_information": [ { "code": "31611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3946.75, "discounted_cash": 3271.0, "minimum": 1184.025, "maximum": 3946.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3946.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3946.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3946.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3565.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3946.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITH CCMCC", "code_information": [ { "code": "116", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14799.0, "minimum": 11548.93, "maximum": 40182.7, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40182.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11548.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40182.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20109.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 26617.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32672.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 26137.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KNEE DISLOC NO ANES FAC", "code_information": [ { "code": "27550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.25, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 323.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Liver SPECT CT w Flow 78831", "code_information": [ { "code": "78831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5434.75, "discounted_cash": 1277.0, "minimum": 1277.43, "maximum": 5434.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5032.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5434.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4890.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4978.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1392.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2160.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Phenylephrine HCl Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "23155062031", "type": "NDC" }, { "code": "J2371", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.37, "10th_percentile": 11.99, "90th_percentile": 102.75, "count": "21" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 63.26, "10th_percentile": 51.37, "90th_percentile": 63.26, "count": "1 through 10" } ] } ] }, { "description": "Hydromorphone HCl Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323085303", "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": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "EBV Capsid Ab, IgG", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.5, "discounted_cash": 18.0, "minimum": 17.6285, "maximum": 157.396, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 272.4, "10th_percentile": 272.4, "90th_percentile": 272.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 229.96, "10th_percentile": 229.96, "90th_percentile": 229.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 162.17, "10th_percentile": 162.17, "90th_percentile": 162.17, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 149.82, "10th_percentile": 149.82, "90th_percentile": 314.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "26525 O CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH (RH)", "code_information": [ { "code": "26525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4821.75, "discounted_cash": 1586.0, "minimum": 1446.525, "maximum": 4821.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4821.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4821.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4821.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Risperdal PAP-no charge - AMB RISPERIDONE (RH)", "code_information": [ { "code": "J2794", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 0.01, "discounted_cash": 11.0, "minimum": 1.0, "maximum": 53.5233, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.52, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.82, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "12004 O SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM (RH)", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.0, "discounted_cash": 197.0, "minimum": 119.4, "maximum": 572.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 572.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 572.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 572.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "J1100 DEXAMETHASNE IMG IN (RH)", "code_information": [ { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3.75, "minimum": 1.0, "maximum": 3.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "40" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 13.87, "10th_percentile": 13.87, "90th_percentile": 14.42, "count": "76" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 4.45, "90th_percentile": 14.84, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 0.44, "90th_percentile": 16.64, "count": "106" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8350.0, "minimum": 6634.79, "maximum": 26600.203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14135.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17350.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13880.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13126.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6634.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8350.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13126.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8350.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10679.04 } ] } ] }, { "description": "37248 FAC TRLUML BALO ANGIOP 1ST VEIN", "code_information": [ { "code": "37248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15183.5, "discounted_cash": 5615.0, "minimum": 4555.05, "maximum": 15183.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15183.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15183.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15183.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "82948 O GLUCOSE BLOOD REAGENT STRIP (RH)", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 5.0, "minimum": 4.575, "maximum": 26.4459, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med CONTRACT RATE COVID VACCINE", "code_information": [ { "code": "91320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.0, "minimum": 48.0, "maximum": 219.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 105.78, "10th_percentile": 105.78, "90th_percentile": 105.78, "count": "1 through 10" } ] } ] }, { "description": "HB ASC REMOVAL OF SESAMOID BONE ASC", "code_information": [ { "code": "28315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "10 MG TRIAMCINOLONE J3301 - AMB TRIAMCINOLONE (RH)", "code_information": [ { "code": "J3301", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7.75, "minimum": 1.8705, "maximum": 6.758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 105.92, "10th_percentile": 52.96, "90th_percentile": 105.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.87 } ] } ] }, { "description": "NM Unlisted Dx Misc Nuc Med", "code_information": [ { "code": "78999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 904.5, "discounted_cash": 394.0, "minimum": 271.35, "maximum": 904.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 904.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 904.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 904.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46145.0, "minimum": 41776.46, "maximum": 118791.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 87294.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 107148.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 85718.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 118790.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41776.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 118791.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 46145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65948.23 } ] } ] }, { "description": "Occ Med CONTRACT RATE Respirator Fit Test", "code_information": [ { "code": "99499", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.0, "minimum": 7.5, "maximum": 540.64, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.0 } ] } ] }, { "description": "90832 O PSYCHTHERPY 30 MN (RH)", "code_information": [ { "code": "90832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 379.5, "discounted_cash": 175.0, "minimum": 113.85, "maximum": 379.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 379.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 379.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 379.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.89, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 296.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTA MMT, Total Body With Hand Units", "code_information": [ { "code": "95834", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.75, "discounted_cash": 30.0, "minimum": 30.9, "maximum": 157.614, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.73, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.88, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.31, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ALT (Alanine Aminotransferase)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 5.0, "minimum": 5.1505, "maximum": 62.784, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 69.0, "10th_percentile": 48.0, "90th_percentile": 69.0, "count": "28" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 54.94, "10th_percentile": 54.94, "90th_percentile": 54.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 58.02, "10th_percentile": 58.02, "90th_percentile": 59.13, "count": "36" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.69, "10th_percentile": 23.69, "90th_percentile": 23.69, "count": "19" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 75.21, "10th_percentile": 5.3, "90th_percentile": 75.9, "count": "52" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Perc Bile Duct Stent + Drn Cath 47540", "code_information": [ { "code": "47540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15266.5, "discounted_cash": 5965.0, "minimum": 4579.95, "maximum": 15266.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15266.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15266.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15266.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6502.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10088.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "82805 O BLD GASES W/O2 SAT (RH)", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.75, "discounted_cash": 78.0, "minimum": 76.5487, "maximum": 342.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 230.33, "10th_percentile": 230.33, "90th_percentile": 230.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 263.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 342.75, "10th_percentile": 342.75, "90th_percentile": 342.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 298.88, "10th_percentile": 298.88, "90th_percentile": 301.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Thoracic Spine w+wo Contrast", "code_information": [ { "code": "72130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.5, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1513.356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1266.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC FIXATION OF SHOULDER ASC", "code_information": [ { "code": "23700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2430.75, "discounted_cash": 1586.0, "minimum": 729.225, "maximum": 2430.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTUBATE ENDOTRACHEAL FAC", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670.75, "discounted_cash": 233.0, "minimum": 201.225, "maximum": 670.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 531.23, "10th_percentile": 531.23, "90th_percentile": 531.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 670.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 670.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 670.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 224.75, "10th_percentile": 224.75, "90th_percentile": 224.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11056 O PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 (RH)", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "discounted_cash": 197.0, "minimum": 41.25, "maximum": 353.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [ { "code": "516", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16852.0, "minimum": 13923.64, "maximum": 91359.7016, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 30592.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37550.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 30040.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44644.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13923.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16852.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44644.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16852.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23111.96 } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "251", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12414.0, "minimum": 10815.27, "maximum": 38763.7267, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22001.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27005.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21604.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 35485.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10815.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12414.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35485.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12414.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16621.35 } ] } ] }, { "description": "Bill HIV GT Genotype", "code_information": [ { "code": "87901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1241.0, "discounted_cash": 257.0, "minimum": 250.1899, "maximum": 1241.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 312.72, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 250.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1241.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 435.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Biopsy Thyroid Percut Needle", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 486.0, "discounted_cash": 698.0, "minimum": 145.8, "maximum": 746.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 381.51, "10th_percentile": 381.51, "90th_percentile": 381.51, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 486.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC TREATMENT OF FOOT INFECTION ASC", "code_information": [ { "code": "28002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2430.75, "discounted_cash": 1586.0, "minimum": 729.225, "maximum": 2430.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Carbamazepine Level", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.25, "discounted_cash": 14.0, "minimum": 14.1591, "maximum": 166.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 121.3, "10th_percentile": 121.3, "90th_percentile": 121.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.7, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "10061 O INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE (RH)", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1013.5, "discounted_cash": 401.0, "minimum": 167.625, "maximum": 1013.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1013.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1013.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1013.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "20612 O ASPIRATION/INJECTION GANGLION CYST ANY LOCAT (RH)", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.5, "discounted_cash": 302.0, "minimum": 65.85, "maximum": 1003.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Sedimentation Rate", "code_information": [ { "code": "85651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.5, "discounted_cash": 4.0, "minimum": 4.1496, "maximum": 71.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 62.2, "10th_percentile": 52.25, "90th_percentile": 62.2, "count": "39" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.53, "10th_percentile": 49.53, "90th_percentile": 52.55, "count": "27" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 53.31, "10th_percentile": 53.31, "90th_percentile": 55.5, "count": "81" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 19.09, "10th_percentile": 19.09, "90th_percentile": 62.2, "count": "31" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 68.42, "10th_percentile": 68.42, "90th_percentile": 71.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "55250 O VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS (RH)", "code_information": [ { "code": "55250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2335.25, "discounted_cash": 2062.0, "minimum": 700.575, "maximum": 2335.25, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2335.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2335.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2335.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2335.25, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "MRI Angio Chest w Contrast", "code_information": [ { "code": "71555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "minimum": 900.0, "maximum": 2616.654, "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": 2278.63 } ] } ] }, { "description": "OT Eval Low Complex", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.5, "discounted_cash": 96.0, "minimum": 93.7884, "maximum": 437.308, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 337.01, "10th_percentile": 337.01, "90th_percentile": 337.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 382.49, "10th_percentile": 382.49, "90th_percentile": 382.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 384.45, "10th_percentile": 384.45, "90th_percentile": 384.45, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 95.84, "10th_percentile": 95.84, "90th_percentile": 437.31, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC ANKLE ARTHROSCOPY SURGERY LIMITED ASC", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "N-STATE 90680 ROTAVIRUS VACCINE PENTAVALENT 3 DOSE LIVE O - AMB ROTOVIRUS (RH)", "code_information": [ { "code": "90680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.5, "minimum": 148.95, "maximum": 432.948, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.44 } ] } ] }, { "description": "62368 O ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG (RH)", "code_information": [ { "code": "62368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.75, "discounted_cash": 303.0, "minimum": 94.425, "maximum": 314.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 314.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 314.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 314.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 303.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 303.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 303.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Pulmonary Stress Testing", "code_information": [ { "code": "94618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.5, "discounted_cash": 131.0, "minimum": 121.65, "maximum": 405.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occult Blood FIT, Stool", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.0, "discounted_cash": 15.0, "minimum": 15.4711, "maximum": 83.5354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 74.4, "10th_percentile": 74.4, "90th_percentile": 74.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 59.24, "10th_percentile": 59.24, "90th_percentile": 59.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 62.56, "10th_percentile": 62.56, "90th_percentile": 63.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 71.16, "10th_percentile": 71.16, "90th_percentile": 74.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.92, "10th_percentile": 15.92, "90th_percentile": 83.54, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PT Manual Therapy Units", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.25, "discounted_cash": 26.0, "minimum": 25.8013, "maximum": 183.338, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.25, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR IVP", "code_information": [ { "code": "74400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1625.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1417.218, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VL Duplex Scan Arterial Upper Bilat - Vascular US Charges", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1585.5, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1382.556, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Procainamide Level", "code_information": [ { "code": "80192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 16.0, "minimum": 16.2777, "maximum": 147.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Hip Bilateral w Pelvis 2 Views", "code_information": [ { "code": "73521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 498.13, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 269.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "54100 O BIOPSY PENIS SEPARATE PROCEDURE (RH)", "code_information": [ { "code": "54100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1231.5, "discounted_cash": 1629.0, "minimum": 369.45, "maximum": 1231.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1231.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Testos Free Male ED/LC-MS/MS", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 357.75, "discounted_cash": 25.0, "minimum": 24.7517, "maximum": 311.958, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "I+D ARM DP ABS/HM FAC", "code_information": [ { "code": "23930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8270.0, "discounted_cash": 2866.0, "minimum": 2481.0, "maximum": 8270.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8270.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8270.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8270.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RPR SUPERFAC WND FAC", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 197.0, "minimum": 167.625, "maximum": 558.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR WRIST JOINT(S) ASC", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 8704.92, "10th_percentile": 8704.92, "90th_percentile": 8704.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 3533.5, "10th_percentile": 3533.5, "90th_percentile": 3533.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC RELEASE PALM CONTRACTURE SKIN GRFT ASC", "code_information": [ { "code": "26123", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 3306.28, "10th_percentile": 3306.28, "90th_percentile": 3306.28, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 7910.58, "10th_percentile": 7910.58, "90th_percentile": 7910.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Salivary Gland", "code_information": [ { "code": "70380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 733.5, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 639.612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Transfuse Blood", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1284.5, "discounted_cash": 435.0, "minimum": 385.35, "maximum": 1284.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 822.02, "10th_percentile": 822.02, "90th_percentile": 822.02, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1284.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1284.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1284.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 937.74, "10th_percentile": 937.74, "90th_percentile": 984.7, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 474.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 984.7, "10th_percentile": 423.12, "90th_percentile": 1120.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 736.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VL ANEURYSM CT AXL BRCH", "code_information": [ { "code": "35011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9172.5, "discounted_cash": 5490.0, "minimum": 2751.75, "maximum": 9172.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9172.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9172.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9172.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9172.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC OPEN TREAT METACARPAL FRACTURE ASC", "code_information": [ { "code": "26615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 4192.67, "10th_percentile": 4192.67, "90th_percentile": 4192.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fetal Non-Stress Test", "code_information": [ { "code": "59025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 484.5, "discounted_cash": 199.0, "minimum": 103.425, "maximum": 484.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 310.13, "10th_percentile": 310.13, "90th_percentile": 310.13, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 484.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 484.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 354.89, "10th_percentile": 354.89, "90th_percentile": 372.58, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 369.53, "10th_percentile": 358.77, "90th_percentile": 369.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 371.42, "10th_percentile": 353.79, "90th_percentile": 707.57, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 365.51, "10th_percentile": 365.51, "90th_percentile": 380.33, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 422.48, "10th_percentile": 406.12, "90th_percentile": 484.5, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37271 REVSC EVSC FPVT ATHRC SF 1st FAC", "code_information": [ { "code": "37271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70981.75, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 70981.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70981.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70981.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "31296 O ENDO DILATION FRONTAL SINUS (RH)", "code_information": [ { "code": "31296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10932.75, "discounted_cash": 6963.0, "minimum": 3279.825, "maximum": 10932.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10932.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10932.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10932.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7590.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10932.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ureaplasma/Mycoplasma hominis Culture", "code_information": [ { "code": "87109", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.25, "discounted_cash": 15.0, "minimum": 14.956, "maximum": 214.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 68.79, "10th_percentile": 68.79, "90th_percentile": 68.79, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 214.73, "10th_percentile": 214.73, "90th_percentile": 214.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CCMCC", "code_information": [ { "code": "437", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7537.0, "minimum": 5434.63, "maximum": 19653.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 12561.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15418.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 12335.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19652.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5434.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19653.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9490.13 } ] } ] }, { "description": "93619 FAC EP COMP W/O INDUCTION", "code_information": [ { "code": "93619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17971.75, "discounted_cash": 7695.0, "minimum": 5391.525, "maximum": 17971.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17971.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17971.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17971.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8388.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13015.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 30 MG/0.3ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "71288043280", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "574", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27449.0, "minimum": 23981.72, "maximum": 75075.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 51104.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 62727.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 50182.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 75075.64 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23981.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27449.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75075.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 27449.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38607.8 } ] } ] }, { "description": "XR Sinuses Limited 1-2 Views", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 374.25, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 374.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 374.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rad Ther Room Level 4", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.25, "minimum": 69.975, "maximum": 283.618, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 186.6, "10th_percentile": 72.07, "90th_percentile": 186.6, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 84.19, "10th_percentile": 84.19, "90th_percentile": 184.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 203.39, "10th_percentile": 203.39, "90th_percentile": 233.25, "count": "1 through 10" } ] } ] }, { "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": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 560.4, "10th_percentile": 560.4, "90th_percentile": 560.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 131.64, "10th_percentile": 131.64, "90th_percentile": 131.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Immunofixation Electrophoresis, Serum", "code_information": [ { "code": "86334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.25, "discounted_cash": 22.0, "minimum": 21.71, "maximum": 244.378, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 138.1, "10th_percentile": 112.06, "90th_percentile": 164.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 138.71, "10th_percentile": 138.71, "90th_percentile": 138.71, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 114.32, "10th_percentile": 112.17, "90th_percentile": 146.48, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 22.34, "10th_percentile": 22.34, "90th_percentile": 180.84, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [ { "code": "792", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19675.0, "minimum": 4315.59, "maximum": 44256.6521, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25874.7, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6551.56, "10th_percentile": 6551.56, "90th_percentile": 6551.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 36055.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44256.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 35405.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 25218.77, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4232.92, "10th_percentile": 4232.92, "90th_percentile": 4232.92, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 4315.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16955.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19675.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4315.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28742.34, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 73063.76, "10th_percentile": 73063.76, "90th_percentile": 73063.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 19675.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27239.22 } ] } ] }, { "description": "Hepatitis D Virus Antibody", "code_information": [ { "code": "86692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.5, "discounted_cash": 17.0, "minimum": 16.6761, "maximum": 222.796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FINGER SPLINT FAC", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 464.0, "discounted_cash": 131.0, "minimum": 80.325, "maximum": 464.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 464.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 464.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 464.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INSERT NON TUN CVC 5YRS FAC", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2773.25, "discounted_cash": 3115.0, "minimum": 198.375, "maximum": 2773.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2773.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bill Chr Anal Per Bld Interpret", "code_information": [ { "code": "88291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.5, "minimum": 91.35, "maximum": 265.524, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.66 } ] } ] }, { "description": "50MG INJ PROMETHAZINE J2550 - AMB PROMETHAZINE (RH)", "code_information": [ { "code": "J2550", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7.75, "minimum": 2.325, "maximum": 7.1165, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.12 } ] } ] }, { "description": "96521 REFILL & MAINT PORT PUMP", "code_information": [ { "code": "96521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.25, "discounted_cash": 209.0, "minimum": 65.175, "maximum": 217.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 217.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 217.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 217.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bill HLA ABC Type", "code_information": [ { "code": "86813", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.25, "discounted_cash": 58.0, "minimum": 56.3644, "maximum": 478.074, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.45, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56.36, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Ankle Left AP+Lateral", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.75, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 311.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 197.57, "10th_percentile": 197.57, "90th_percentile": 197.57, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 311.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 311.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 228.56, "10th_percentile": 228.56, "90th_percentile": 228.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 258.72, "10th_percentile": 258.72, "90th_percentile": 258.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med Chromium, Blood", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 20.0, "minimum": 18.0, "maximum": 106.4132, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Lung Perfusion Scan", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 978.5, "discounted_cash": 394.0, "minimum": 293.55, "maximum": 978.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 978.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 978.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 978.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 978.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "26725 O CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA (RH)", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1822.5, "discounted_cash": 243.0, "minimum": 108.525, "maximum": 1589.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "33240 FAC INS ICD GENERATOR", "code_information": [ { "code": "33240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95024.25, "discounted_cash": 21947.0, "minimum": 21947.8, "maximum": 95024.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86465.55, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95024.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84031.54, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23923.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37118.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Valproic", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 13.0, "minimum": 13.1582, "maximum": 146.496, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 60.52, "10th_percentile": 60.52, "90th_percentile": 60.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Ventricular Puncture w Injection", "code_information": [ { "code": "61026", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 881.75, "discounted_cash": 696.0, "minimum": 264.525, "maximum": 881.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 881.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 881.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 881.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 881.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Analyze Neurostim Complex", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 875.5, "discounted_cash": 93.0, "minimum": 93.8, "maximum": 763.436, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 369.53, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 448.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 359.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 158.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "40654 O RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE (RH)", "code_information": [ { "code": "40654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3944.5, "discounted_cash": 1530.0, "minimum": 765.75, "maximum": 3944.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3944.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3944.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3944.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XM AHG Interp (Automated)", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 168.0, "minimum": 61.2, "maximum": 204.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 320.28, "10th_percentile": 320.28, "90th_percentile": 320.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 204.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 204.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 204.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 274.46, "10th_percentile": 274.46, "90th_percentile": 274.46, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 177.89, "10th_percentile": 177.89, "90th_percentile": 711.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 204.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Embolization w TriNav C9797", "code_information": [ { "code": "C9797", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44638.5, "discounted_cash": 18087.0, "minimum": 13391.55, "maximum": 44638.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44638.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44638.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44638.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BIMALL ANKLE FX MANI FAC", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 448.0, "discounted_cash": 1586.0, "minimum": 134.4, "maximum": 448.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37184 FAC PRIM ART MECH THROMBECTOM", "code_information": [ { "code": "37184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11735.5, "discounted_cash": 18087.0, "minimum": 3520.65, "maximum": 11735.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11735.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LILETTA J7297 - AMB LEVONORGESTREL (RH)", "code_information": [ { "code": "J7297", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3196.5, "minimum": 958.95, "maximum": 2787.348, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2043.3 } ] } ] }, { "description": "MRI Implant initial 15 minutes 76014", "code_information": [ { "code": "76014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.5, "discounted_cash": 28.0, "minimum": 22.05, "maximum": 73.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 73.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "59841 O INDUCED ABORT D&E (RH)", "code_information": [ { "code": "59841", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2536.75, "discounted_cash": 3194.0, "minimum": 761.025, "maximum": 2536.75, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2536.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "POC Occult Blood Stool (RH)", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 4.0, "minimum": 4.2565, "maximum": 52.756, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Arsenic Level, Blood", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.75, "discounted_cash": 18.0, "minimum": 7.5, "maximum": 41.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 41.75, "10th_percentile": 41.75, "90th_percentile": 41.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 28.62, "10th_percentile": 28.62, "90th_percentile": 28.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 36.74, "10th_percentile": 36.74, "90th_percentile": 37.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Digoxin", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.75, "discounted_cash": 13.0, "minimum": 12.9055, "maximum": 124.478, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 59.36, "10th_percentile": 59.36, "90th_percentile": 59.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 96.03, "10th_percentile": 96.03, "90th_percentile": 96.03, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.36, "10th_percentile": 59.36, "90th_percentile": 59.36, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 69.68, "10th_percentile": 69.68, "90th_percentile": 69.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DRAIN TENDON SHEATH FAC", "code_information": [ { "code": "26020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1683.25, "discounted_cash": 3228.0, "minimum": 504.975, "maximum": 1683.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1683.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Aph DRBC ACDA AS3", "code_information": [ { "code": "P9021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1402.0, "discounted_cash": 149.0, "minimum": 149.83, "maximum": 1222.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 590.27, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 717.04, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 573.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 253.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14187.0, "minimum": 12164.93, "maximum": 33455.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 25434.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31219.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 24975.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33455.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12164.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14187.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33455.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14187.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19214.93 } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CCMCC", "code_information": [ { "code": "195", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 4309.91, "maximum": 13011.4299, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 9252.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11356.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 9085.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9728.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4309.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9728.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 5828.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6989.98 } ] } ] }, { "description": "Immunofixation IFE, Urine", "code_information": [ { "code": "86335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.75, "discounted_cash": 29.0, "minimum": 28.5223, "maximum": 189.878, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Calcaneous Right Min 2 Views", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 372.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 280.8, "10th_percentile": 280.8, "90th_percentile": 280.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 272.87, "10th_percentile": 272.87, "90th_percentile": 272.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [ { "code": "806", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6782.0, "minimum": 5008.27, "maximum": 13624.6594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 10716.4, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13711.84, "10th_percentile": 13095.39, "90th_percentile": 20433.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11100.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13624.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10899.72 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 10129.38, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5169.74, "10th_percentile": 4734.64, "90th_percentile": 13731.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 10411.97, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4715.4, "10th_percentile": 4715.4, "90th_percentile": 10683.35, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9392.98 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 11876.77, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6759.57, "10th_percentile": 6759.57, "90th_percentile": 22647.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5008.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6782.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9392.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 11904.08, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8460.63, "10th_percentile": 5878.57, "90th_percentile": 25584.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6782.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8385.75 } ] } ] }, { "description": "Factor VIII Activity", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.5, "discounted_cash": 17.0, "minimum": 17.3952, "maximum": 114.668, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 80.01, "10th_percentile": 80.01, "90th_percentile": 80.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 114.67, "10th_percentile": 114.67, "90th_percentile": 114.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SLP Non-Speech AAC Device Tx Units", "code_information": [ { "code": "92606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.5, "minimum": 95.0, "maximum": 445.156, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "36558 FAC INS TUNNELED CVC > 5YRS", "code_information": [ { "code": "36558", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6830.75, "discounted_cash": 3115.0, "minimum": 2049.225, "maximum": 6830.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6830.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6830.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6830.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "28450 O TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ (RH)", "code_information": [ { "code": "28450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1543.5, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 1345.932, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "URINARY STONES WITH MCC", "code_information": [ { "code": "693", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11273.0, "minimum": 10177.12, "maximum": 29077.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19793.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24294.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 19435.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29077.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10177.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11273.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29077.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11273.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14953.1 } ] } ] }, { "description": "OT Orthotic Management, Initial 15", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.25, "discounted_cash": 43.0, "minimum": 33.375, "maximum": 97.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.01, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "$ Comprehensive Metabolic Panel 80053", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.5, "discounted_cash": 10.0, "minimum": 10.2, "maximum": 235.004, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 203.4, "10th_percentile": 170.86, "90th_percentile": 203.4, "count": "354" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 12.83, "10th_percentile": 12.83, "90th_percentile": 12.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 171.67, "10th_percentile": 161.96, "90th_percentile": 235.0, "count": "11" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 174.31, "10th_percentile": 174.31, "90th_percentile": 181.29, "count": "640" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 47.2, "10th_percentile": 47.2, "90th_percentile": 203.4, "count": "197" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 223.74, "10th_percentile": 55.41, "90th_percentile": 235.0, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "832", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6536.0, "minimum": 5173.0, "maximum": 13039.1965, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 7115.91, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9547.62, "10th_percentile": 9547.62, "90th_percentile": 9547.62, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 10623.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13039.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10431.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8707.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5173.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6536.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8707.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 7904.55, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11524.48, "10th_percentile": 11524.48, "90th_percentile": 11524.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6536.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8025.4 } ] } ] }, { "description": "54235 O NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT (RH)", "code_information": [ { "code": "54235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.5, "discounted_cash": 246.0, "minimum": 180.75, "maximum": 729.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 602.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 602.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 602.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Urea Nitrogen, Random Urine", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.25, "discounted_cash": 5.0, "minimum": 5.4032, "maximum": 58.642, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Mycoplasma genitalium, rRNA, TMA", "code_information": [ { "code": "87563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 475.25, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 414.418, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 156.85, "10th_percentile": 156.85, "90th_percentile": 156.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 414.42, "10th_percentile": 414.42, "90th_percentile": 414.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC N BLOCK OTHER PERIPHERAL ASC", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 829.75, "discounted_cash": 696.0, "minimum": 72.375, "maximum": 1318.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 829.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 829.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 829.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 829.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11623 O EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/< (RH)", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1388.25, "discounted_cash": 1629.0, "minimum": 416.475, "maximum": 1388.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1388.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "G0008 F ADMIN FLU VACCINE (RH)", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.5, "discounted_cash": 71.0, "minimum": 6.45, "maximum": 21.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 14.45, "10th_percentile": 14.45, "90th_percentile": 14.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 16.48, "10th_percentile": 16.48, "90th_percentile": 16.48, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.03, "10th_percentile": 17.03, "90th_percentile": 17.03, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18506.0, "minimum": 16381.4, "maximum": 81689.6838, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 33794.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41481.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 33184.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49645.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16381.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18506.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49645.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 18506.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25530.93 } ] } ] }, { "description": "zzMaternal Serum Screen, Integrated Spec 1", "code_information": [ { "code": "84163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.75, "discounted_cash": 15.0, "minimum": 14.6256, "maximum": 175.054, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "56605 O BIOPSY VULVA/PERINEUM 1 LESION SPX (RH)", "code_information": [ { "code": "56605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 465.5, "discounted_cash": 908.0, "minimum": 139.65, "maximum": 465.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 465.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Amniocentesis Dx", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 460.5, "discounted_cash": 908.0, "minimum": 138.15, "maximum": 592.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "51710 O CHANGE CYSTOSTOMY TUBE COMPLICATED (RH)", "code_information": [ { "code": "51710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 467.25, "discounted_cash": 688.0, "minimum": 140.175, "maximum": 7489.826, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 467.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI", "code_information": [ { "code": "57160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 657.5, "discounted_cash": 199.0, "minimum": 155.85, "maximum": 657.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 657.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 657.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 657.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REMOVAL OF BONE CYST ASC", "code_information": [ { "code": "28104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR FINGER HAND TENDON EA TEND ASC", "code_information": [ { "code": "26356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20788.0, "minimum": 17670.16, "maximum": 71411.5539, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 38211.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46902.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 37521.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51989.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17670.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20788.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51989.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 20788.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28867.43 } ] } ] }, { "description": "MRI Angio Neck wo Contrast", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1524.25, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1456.6532, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1456.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 584.25, "10th_percentile": 584.25, "90th_percentile": 584.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "62287 O DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR (RH)", "code_information": [ { "code": "62287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4865.5, "discounted_cash": 1926.0, "minimum": 1459.65, "maximum": 4865.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4865.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4865.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4865.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2100.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3258.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "373", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6580.0, "minimum": 5020.73, "maximum": 18179.1212, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 10708.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13144.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10515.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10248.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5020.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6580.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10248.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6580.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8089.91 } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [ { "code": "521", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22877.0, "minimum": 20173.6, "maximum": 84096.2019, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 42253.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 51864.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 41491.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 62072.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20173.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62072.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 22877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31921.45 } ] } ] }, { "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": 22727.0, "minimum": 20156.3, "maximum": 95394.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 41963.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 51508.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 41206.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 95394.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20156.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22727.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 95394.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 22727.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31702.35 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25786.0, "minimum": 23575.43, "maximum": 58777.5756, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 47886.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58777.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 47022.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48741.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23575.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48741.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 25786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36176.6 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9541.0, "minimum": 7349.07, "maximum": 28846.1191, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25968.12, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 490.45, "10th_percentile": 490.45, "90th_percentile": 23592.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 16440.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20180.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 16144.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 24545.67, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 34307.05, "10th_percentile": 34307.05, "90th_percentile": 34307.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 25309.82, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16032.53, "10th_percentile": 16032.53, "90th_percentile": 16032.53, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22405.98 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 28779.96, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22577.52, "10th_percentile": 22577.52, "90th_percentile": 22577.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7349.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22406.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28846.12, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 42036.85, "10th_percentile": 30050.83, "90th_percentile": 65338.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12420.69 } ] } ] }, { "description": "92924-LD FAC PTCA W/ANGPLSTY SNGL A/V", "code_information": [ { "code": "92924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28058.25, "discounted_cash": 11390.0, "minimum": 8417.475, "maximum": 28058.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28058.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28058.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28058.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cryoglobulin, Qual Reflex Qual IgA, G+M", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.5, "discounted_cash": 6.0, "minimum": 6.2875, "maximum": 24.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 24.5, "10th_percentile": 24.5, "90th_percentile": 24.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 21.36, "10th_percentile": 21.36, "90th_percentile": 21.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Cervical Spine w Contrast", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2606.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2272.432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1017.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REPOSITION CVC W FLUORO FAC", "code_information": [ { "code": "36597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1092.25, "discounted_cash": 1553.0, "minimum": 225.0, "maximum": 1092.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "29065 O APPLICATION CAST SHOULDER HAND LONG ARM (RH)", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 275.0, "minimum": 88.875, "maximum": 558.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lacosamide (Vimpat) Level", "code_information": [ { "code": "80339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 699.5, "minimum": 26.236, "maximum": 609.964, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.24 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 580.8, "10th_percentile": 580.8, "90th_percentile": 580.8, "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": 25591.0, "minimum": 22281.84, "maximum": 139799.694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 47507.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58313.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 46650.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69791.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22281.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25591.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69791.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 25591.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35890.77 } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [ { "code": "970", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21106.0, "minimum": 18364.36, "maximum": 57037.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 38826.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 47657.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 38125.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 57037.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18364.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21106.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57037.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 21106.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29332.32 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6386.0, "minimum": 4833.16, "maximum": 14822.5747, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 10333.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12683.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10146.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 13005.45, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7114.54, "10th_percentile": 7114.54, "90th_percentile": 7114.54, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11321.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4833.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6386.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11321.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6386.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7806.31 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18326.0, "minimum": 15683.73, "maximum": 41052.8695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 33445.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41052.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 32842.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36901.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15683.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18326.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36901.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 18326.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25267.34 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8077.0, "minimum": 6111.53, "maximum": 19990.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 13607.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16701.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13361.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19990.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6111.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19990.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10279.77 } ] } ] }, { "description": "200MG Misoprostol Pill S0191 - AMB MISOPROSTOL (RH)", "code_information": [ { "code": "S0191", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6.75, "minimum": 2.025, "maximum": 5.886, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.13 } ] } ] }, { "description": "IR Hepatic Venogram wo Press 75891", "code_information": [ { "code": "75891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6086.75, "discounted_cash": 3115.0, "minimum": 640.6242, "maximum": 6086.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6086.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6086.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6086.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "51101 O ASPIRATION BLADDER TROCAR/INTRACATHETER (RH)", "code_information": [ { "code": "51101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 432.75, "discounted_cash": 847.0, "minimum": 129.825, "maximum": 432.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "33271 FAC INS SUBQ DEFIB ELECTRODE", "code_information": [ { "code": "33271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19830.25, "discounted_cash": 8165.0, "minimum": 5949.075, "maximum": 19830.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19830.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19830.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19830.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC OPEN TRMT OF METATARSAL FRCTR W/WO INT FIX ASC", "code_information": [ { "code": "28485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13019.0, "discounted_cash": 7159.0, "minimum": 3905.7, "maximum": 13019.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13019.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13019.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13019.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIM REP TRK <2.5 FAC", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.25, "discounted_cash": 197.0, "minimum": 71.775, "maximum": 345.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 220.92, "10th_percentile": 220.92, "90th_percentile": 220.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 345.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 345.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 345.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 255.57, "10th_percentile": 255.57, "90th_percentile": 263.32, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 260.37, "10th_percentile": 260.37, "90th_percentile": 260.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 289.3, "10th_percentile": 289.3, "90th_percentile": 301.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Temp Bones w Contrast", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1804.5, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1573.524, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1161.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1573.52, "10th_percentile": 1573.52, "90th_percentile": 1573.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Remove-Repl Ext Ureteral Stent w S+I", "code_information": [ { "code": "50387", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3484.25, "discounted_cash": 2062.0, "minimum": 1045.275, "maximum": 3484.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3484.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3484.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3484.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3484.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11303 O SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM (RH)", "code_information": [ { "code": "11303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 595.25, "discounted_cash": 401.0, "minimum": 178.575, "maximum": 595.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 595.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 595.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 595.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 595.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "95028 INTRACUTANEOUS TEST", "code_information": [ { "code": "95028", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.25, "discounted_cash": 36.0, "minimum": 21.675, "maximum": 72.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "74177 FAC CT ABD PELVIS W CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2767.25, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2413.042, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1592.47, "10th_percentile": 1592.47, "90th_percentile": 1592.47, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1842.24, "10th_percentile": 1842.24, "90th_percentile": 1915.9, "count": "42" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1986.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 871.83, "10th_percentile": 871.83, "90th_percentile": 1592.47, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2190.46, "10th_percentile": 2190.46, "90th_percentile": 2190.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "89322 O SEMEN ANLY COUNT (RH)", "code_information": [ { "code": "89322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.25, "discounted_cash": 15.0, "minimum": 15.0629, "maximum": 267.922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 194.71, "10th_percentile": 194.71, "90th_percentile": 194.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 254.98, "10th_percentile": 254.98, "90th_percentile": 254.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bill Chr Anal CLL Cytogenetics", "code_information": [ { "code": "88275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 985.25, "discounted_cash": 51.0, "minimum": 49.7464, "maximum": 859.138, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.18, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.75, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.57, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "0.25MG CORTROSYN J0834 - AMB COSYNTROPIN (RH)", "code_information": [ { "code": "J0834", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 414.75, "minimum": 71.81, "maximum": 361.662, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.81 } ] } ] }, { "description": "CARDIOVERSION FAC", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1078.0, "discounted_cash": 652.0, "minimum": 323.4, "maximum": 1078.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 813.19, "10th_percentile": 813.19, "90th_percentile": 813.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1078.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1078.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1078.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 822.19, "10th_percentile": 822.19, "90th_percentile": 822.19, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 940.02, "10th_percentile": 940.02, "90th_percentile": 940.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1078.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Repair CVAD w Port", "code_information": [ { "code": "36576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2776.0, "discounted_cash": 1553.0, "minimum": 832.8, "maximum": 2776.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2776.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2776.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2776.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [ { "code": "690", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7204.0, "minimum": 5555.06, "maximum": 21556.715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 19405.99, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8945.1, "10th_percentile": 8945.1, "90th_percentile": 8945.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11917.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14627.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 11702.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11590.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5555.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7204.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11590.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7204.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9003.0 } ] } ] }, { "description": "B-Cell Receptor IGK Gene Rearrangement, PCR", "code_information": [ { "code": "81264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 700.0, "discounted_cash": 172.0, "minimum": 167.859, "maximum": 700.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 209.82, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 167.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Kleihauer-Betke (RhIG))", "code_information": [ { "code": "85460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.25, "discounted_cash": 7.0, "minimum": 7.512, "maximum": 274.898, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 34.55, "10th_percentile": 34.55, "90th_percentile": 34.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.39, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 212.07, "10th_percentile": 212.07, "90th_percentile": 212.07, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FAC CYSTOURETHROSCPY w CALIB/DILATN URETHRAL STEN", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6094.25, "discounted_cash": 2062.0, "minimum": 425.925, "maximum": 6094.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6094.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6094.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6094.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Computer XM OK - XM Electronic Interp", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.0, "discounted_cash": 168.0, "minimum": 23.1, "maximum": 77.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.74, "10th_percentile": 51.74, "90th_percentile": 51.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 52.79, "10th_percentile": 51.8, "90th_percentile": 103.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.76, "10th_percentile": 67.14, "90th_percentile": 663.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8266.0, "minimum": 6852.12, "maximum": 17901.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 13972.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17150.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13720.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17901.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6852.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17901.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8266.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10555.59 } ] } ] }, { "description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "956", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29667.0, "minimum": 26456.09, "maximum": 150749.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 55397.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 67996.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 54397.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 150749.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26456.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29667.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 150749.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 29667.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41850.88 } ] } ] }, { "description": "11643 O EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/< (RH)", "code_information": [ { "code": "11643", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1918.25, "discounted_cash": 1629.0, "minimum": 575.475, "maximum": 1918.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1918.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1918.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1918.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1918.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "810", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9007.0, "minimum": 6587.72, "maximum": 32735.3422, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15407.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18911.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 15129.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11701.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6587.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9007.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11701.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9007.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11639.95 } ] } ] }, { "description": "TRT HUMERUS FRACT FAC", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703.0, "discounted_cash": 243.0, "minimum": 210.9, "maximum": 1748.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 703.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Bone Survey Limited", "code_information": [ { "code": "77076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.5, "discounted_cash": 103.0, "minimum": 82.65, "maximum": 275.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 275.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 275.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 275.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 275.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC KNEE ARTHROSCOPY DX ASC", "code_information": [ { "code": "29870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4687.0, "discounted_cash": 3228.0, "minimum": 1406.1, "maximum": 4687.0, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4687.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4687.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4687.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4687.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12721.0, "minimum": 10596.56, "maximum": 33194.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22596.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27735.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 22188.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33193.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10596.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12721.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33194.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12721.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17070.67 } ] } ] }, { "description": "REPAIR FINGER TENDON CLOSED FAC", "code_information": [ { "code": "26432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5081.5, "discounted_cash": 1586.0, "minimum": 1524.45, "maximum": 5081.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5081.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5081.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5081.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INT REP HAND FT <2.5 FAC", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 401.0, "minimum": 167.625, "maximum": 1539.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "1MG VITAMIN K J3430 - AMB PHYTONADIONE (RH)", "code_information": [ { "code": "J3430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.75, "minimum": 5.2675, "maximum": 30.302, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.27 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5842.0, "minimum": 4406.81, "maximum": 18378.486, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 9280.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11391.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 9112.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10298.96 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 18336.33, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20188.92, "10th_percentile": 20188.92, "90th_percentile": 20188.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4406.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5842.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10299.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 5842.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7011.11 } ] } ] }, { "description": "CT Angiography Pelvis w+wo Contrast", "code_information": [ { "code": "72191", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1825.75, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1825.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1592.05, "10th_percentile": 1592.05, "90th_percentile": 1592.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IHC ERA Quant 88360 AP Bill", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 168.0, "minimum": 149.25, "maximum": 497.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 334.32, "10th_percentile": 240.41, "90th_percentile": 714.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 334.67, "10th_percentile": 245.27, "90th_percentile": 1162.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 497.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 625.0, "10th_percentile": 625.0, "90th_percentile": 625.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 433.82, "10th_percentile": 314.82, "90th_percentile": 623.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7549.0, "minimum": 6018.79, "maximum": 17694.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 12583.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15446.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 12356.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17694.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6018.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7549.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17694.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7549.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9506.81 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47656.0, "minimum": 41464.3, "maximum": 110739.2075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 90219.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 110739.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 88591.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 79404.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41464.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47656.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79404.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 47656.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68158.1 } ] } ] }, { "description": "MA US BX L Muscle Perc 20206", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1167.0, "discounted_cash": 1629.0, "minimum": 345.225, "maximum": 1167.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1167.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [ { "code": "152", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10039.0, "minimum": 7854.33, "maximum": 21362.1648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17403.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21362.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 17089.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12798.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7854.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10039.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12798.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10039.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13148.05 } ] } ] }, { "description": "$ AP 88356 Morphometric, Nerve", "code_information": [ { "code": "88356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 945.25, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 824.258, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 760.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16260.0, "minimum": 13648.17, "maximum": 107497.7271, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 28914.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44110.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13648.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16260.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44110.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16260.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22245.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 29445.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36143.29 } ] } ] }, { "description": "Folate, RBC", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.0, "discounted_cash": 17.0, "minimum": 17.1523, "maximum": 180.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "727", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12326.0, "minimum": 10170.2, "maximum": 81076.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 21830.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26795.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21436.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32069.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10170.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12326.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32069.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12326.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16492.34 } ] } ] }, { "description": "14060 O ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< (RH)", "code_information": [ { "code": "14060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5779.75, "discounted_cash": 2035.0, "minimum": 1733.925, "maximum": 6275.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5779.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5779.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5779.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11106 O INCISION BX SKN 1ST LES (RH)", "code_information": [ { "code": "11106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 425.0, "discounted_cash": 729.0, "minimum": 127.5, "maximum": 1795.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "14001 O ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM (RH)", "code_information": [ { "code": "14001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5528.0, "discounted_cash": 2035.0, "minimum": 1658.4, "maximum": 5528.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5528.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5528.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5528.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Toxocara canis Ab, IgG", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.0, "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 294.736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INJ ANES AGENT SPHENOPALATINE GANGLION FAC", "code_information": [ { "code": "64505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.5, "discounted_cash": 302.0, "minimum": 231.15, "maximum": 882.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 882.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 882.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 882.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Midazolam HCl Oral/Rectal/Inj 5 MG/ML (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641606101", "type": "NDC" }, { "code": "J2250", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 30.26, "10th_percentile": 30.26, "90th_percentile": 30.26, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 13.97, "10th_percentile": 13.97, "90th_percentile": 18.35, "count": "1 through 10" } ] } ] }, { "description": "Ionized Calcium", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.75, "discounted_cash": 13.0, "minimum": 13.2942, "maximum": 164.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 151.0, "10th_percentile": 151.0, "90th_percentile": 151.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 129.41, "10th_percentile": 129.41, "90th_percentile": 129.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 164.59, "10th_percentile": 13.68, "90th_percentile": 164.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36224 FAC ANGIO INTR CARTD W/IPS IN", "code_information": [ { "code": "36224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12013.75, "discounted_cash": 5490.0, "minimum": 3604.125, "maximum": 12013.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12013.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12013.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12013.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "21501 O I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX (RH)", "code_information": [ { "code": "21501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3181.25, "discounted_cash": 2866.0, "minimum": 954.375, "maximum": 3181.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3181.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3181.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3181.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3181.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "13132 O REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM (RH)", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3090.25, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 2694.698, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1919.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RML FOREIGN BODY FAC", "code_information": [ { "code": "65235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6345.5, "discounted_cash": 2277.0, "minimum": 1903.65, "maximum": 6345.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2277.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6345.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6345.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2277.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6345.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2277.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2277.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2482.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2277.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2277.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2277.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2277.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2277.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3851.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AUARC MCR", "code_information": [ { "code": "P9022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 829.5, "discounted_cash": 366.0, "minimum": 248.85, "maximum": 1755.2512, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 829.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 829.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 829.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 399.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 620.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "599", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6899.0, "minimum": 5917.05, "maximum": 16638.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11326.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13902.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 11122.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16638.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5917.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6899.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16638.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6899.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8557.02 } ] } ] }, { "description": "OT Massage Units", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.0, "discounted_cash": 28.0, "minimum": 27.3853, "maximum": 189.442, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "POTASSIUM CHLORIDE 20 MEQ/250ML IV SOLN", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "99999-0965-10", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" } ] } ] }, { "description": "SKIN ULCERS WITH CC", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10070.0, "minimum": 8462.71, "maximum": 32213.5897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17464.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21436.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 17148.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17811.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8462.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10070.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17811.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10070.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13193.65 } ] } ] }, { "description": "31502 O TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT (RH)", "code_information": [ { "code": "31502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.5, "discounted_cash": 233.0, "minimum": 126.75, "maximum": 655.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 422.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 422.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 422.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [ { "code": "077", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10702.45, "maximum": 10702.45, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10702.45 } ] } ] }, { "description": "NASAL HEMORR POST 1 FAC", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.5, "discounted_cash": 131.0, "minimum": 117.45, "maximum": 826.656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 391.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 391.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 391.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Continuous Nebulizer Treatment Initial", "code_information": [ { "code": "94644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.25, "discounted_cash": 131.0, "minimum": 126.075, "maximum": 420.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 420.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 322.16, "10th_percentile": 322.16, "90th_percentile": 322.16, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Lumbar Spine w+wo Contrast", "code_information": [ { "code": "72133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2028.75, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1769.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1260.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6547.0, "minimum": 5018.66, "maximum": 24219.1659, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 10645.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13066.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10453.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 21250.1, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 24611.3, "10th_percentile": 24611.3, "90th_percentile": 24611.3, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18945.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5018.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6547.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18945.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6547.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8042.09 } ] } ] }, { "description": "22900 O EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM (RH)", "code_information": [ { "code": "22900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4425.0, "discounted_cash": 2866.0, "minimum": 1327.5, "maximum": 4425.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4425.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4425.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4425.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4425.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 36.0, "minimum": 36.85, "maximum": 359.264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 659.2, "10th_percentile": 276.86, "90th_percentile": 659.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 524.89, "10th_percentile": 524.89, "90th_percentile": 524.89, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 282.47, "10th_percentile": 277.15, "90th_percentile": 564.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 105.22, "10th_percentile": 105.22, "90th_percentile": 105.22, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 359.26, "10th_percentile": 345.5, "90th_percentile": 725.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IGVH Status", "code_information": [ { "code": "81263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1025.0, "discounted_cash": 294.0, "minimum": 286.2145, "maximum": 1025.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.75, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 286.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 498.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FB CONJUNCT EMBED FAC", "code_information": [ { "code": "65210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 395.5, "discounted_cash": 440.0, "minimum": 118.65, "maximum": 395.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DEBRIDE INF SKIN <10% FAC", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 401.0, "minimum": 41.4, "maximum": 648.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 648.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 648.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 648.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 648.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 59192.0, "minimum": 54099.88, "maximum": 178768.2491, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 112548.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 138147.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 110517.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 162973.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54099.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59192.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 162973.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 59192.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 85027.47 } ] } ] }, { "description": "Chloride, Stool", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.25, "discounted_cash": 5.0, "minimum": 4.859, "maximum": 65.618, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ELBOW DISLOC NO ANES FAC", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.75, "discounted_cash": 243.0, "minimum": 116.325, "maximum": 2363.556, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 387.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 387.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 387.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "I+D PILONDIAL CYST COM FAC", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5492.75, "discounted_cash": 698.0, "minimum": 315.375, "maximum": 4789.678, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Duplex Scan Penile Vessel Limited", "code_information": [ { "code": "93981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 978.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 852.816, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "200MG MIFEPREX Pill S0190 - AMB MIFEPRISTONE (RH)", "code_information": [ { "code": "S0190", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.75, "minimum": 78.5825, "maximum": 349.454, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.58 } ] } ] }, { "description": "APPLY LONG LEG CAST FAC", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.75, "discounted_cash": 275.0, "minimum": 128.025, "maximum": 594.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 426.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 426.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 426.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 426.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "69105 O BIOPSY EXTERNAL AUDITORY CANAL (RH)", "code_information": [ { "code": "69105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 836.75, "discounted_cash": 1530.0, "minimum": 251.025, "maximum": 836.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 836.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Neck w Contrast", "code_information": [ { "code": "70542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1947.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1757.9442, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1757.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "344", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20691.0, "minimum": 18649.52, "maximum": 55857.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 38022.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46670.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 37336.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 55857.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18649.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55857.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 20691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28725.08 } ] } ] }, { "description": "CL TRMT ACETAB W MAN FAC", "code_information": [ { "code": "27222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 639.5, "discounted_cash": 243.0, "minimum": 191.85, "maximum": 639.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 639.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 639.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 639.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Erythrocyte Porphyrin (EP), Whole Blood", "code_information": [ { "code": "84202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.5, "discounted_cash": 14.0, "minimum": 13.9453, "maximum": 306.508, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.43, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19922.0, "minimum": 17489.51, "maximum": 98648.5098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 36534.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44843.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 35875.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 65579.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17489.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19922.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65579.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 19922.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27600.67 } ] } ] }, { "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": 55599.0, "minimum": 46226.87, "maximum": 129609.5414, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 105593.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 129609.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 103687.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78832.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46226.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55599.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78832.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 55599.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79772.47 } ] } ] }, { "description": "20999 O UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL (RH)", "code_information": [ { "code": "20999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436.0, "discounted_cash": 243.0, "minimum": 130.8, "maximum": 436.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 436.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 436.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 436.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36600 O ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX (RH)", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.25, "discounted_cash": 131.0, "minimum": 37.575, "maximum": 129.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [ { "code": "278", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43381.0, "minimum": 34629.49, "maximum": 108425.5351, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 81942.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 100580.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 80464.21 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 92261.18, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 89871.41, "10th_percentile": 89871.41, "90th_percentile": 89871.41, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71747.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34629.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43381.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71747.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 43381.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61905.5 } ] } ] }, { "description": "92933 FAC DES ATHERECTMY W/STNT SNG", "code_information": [ { "code": "92933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22348.75, "discounted_cash": 18087.0, "minimum": 6704.625, "maximum": 22348.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22348.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "45331 O SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE (RH)", "code_information": [ { "code": "45331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575.0, "discounted_cash": 917.0, "minimum": 172.5, "maximum": 575.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1291.15, "10th_percentile": 1291.15, "90th_percentile": 3644.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 575.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "24000 O ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB (RH)", "code_information": [ { "code": "24000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3699.25, "discounted_cash": 3228.0, "minimum": 1109.775, "maximum": 3699.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3699.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3699.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3699.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3699.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Transcut Bilirubin Test", "code_information": [ { "code": "88720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.25, "discounted_cash": 5.0, "minimum": 4.8784, "maximum": 27.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 26.34, "10th_percentile": 26.34, "90th_percentile": 26.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Biopsy Stereotactic Needle", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2523.5, "discounted_cash": 3863.0, "minimum": 567.675, "maximum": 2523.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2523.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Drainage Cath Placement 75989", "code_information": [ { "code": "75989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2201.25, "minimum": 500.2154, "maximum": 1919.49, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.22 } ] } ] }, { "description": "HB ASC REVISE FINGER JOINT ASC", "code_information": [ { "code": "26535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine Inj 2% w/ Epinephrine-1:200000 (PF)", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409318311", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "CT Simulation Intermediate", "code_information": [ { "code": "77285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1353.25, "discounted_cash": 369.0, "minimum": 369.45, "maximum": 1353.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1353.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1353.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1353.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 402.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 624.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27814.0, "minimum": 25253.86, "maximum": 84708.4983, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 51810.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 63594.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 50875.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 79122.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25253.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27814.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79122.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 27814.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39141.64 } ] } ] }, { "description": "43259 FAC IR EUS", "code_information": [ { "code": "43259", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2935.0, "discounted_cash": 1893.0, "minimum": 880.5, "maximum": 2935.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2935.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2935.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2935.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2063.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2935.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REM FB UP ARM SUBQ FAC", "code_information": [ { "code": "24200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 595.0, "discounted_cash": 1629.0, "minimum": 178.5, "maximum": 1380.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 595.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "75833 FAC VENOGRAM RENAL BILATERAL", "code_information": [ { "code": "75833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7562.25, "discounted_cash": 3115.0, "minimum": 696.1643, "maximum": 7562.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7562.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7562.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7562.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 696.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7459.0, "minimum": 5946.11, "maximum": 18482.2202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 12410.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15232.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 12186.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14620.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5946.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14620.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 18482.22, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15698.72, "10th_percentile": 15698.72, "90th_percentile": 15698.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7459.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9375.58 } ] } ] }, { "description": "HB ASC RECONSTRUCT ULNA RADIOULNAR ASC", "code_information": [ { "code": "25337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10070.5, "discounted_cash": 7159.0, "minimum": 3021.15, "maximum": 10070.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REDUCTION OF RECTAL PROLAPSE FAC", "code_information": [ { "code": "45900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2456.0, "discounted_cash": 917.0, "minimum": 736.8, "maximum": 2456.0, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1551.83, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2456.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2456.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2456.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Magnesium Sulfate IV Soln 4 GM/100ML (40 MG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338171540", "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": 87.0, "median_amount": 72.46, "10th_percentile": 72.46, "90th_percentile": 144.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.49, "10th_percentile": 80.49, "90th_percentile": 80.49, "count": "1 through 10" } ] } ] }, { "description": "11606 O EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM (RH)", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2801.75, "discounted_cash": 1629.0, "minimum": 840.525, "maximum": 2801.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2801.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2801.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2801.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "20600 O ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA (RH)", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.5, "discounted_cash": 302.0, "minimum": 61.95, "maximum": 1518.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 114.28, "10th_percentile": 57.14, "90th_percentile": 114.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 206.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "62327 O NJX INTERLAMINAR LMBR/SAC W IMAGE (RH)", "code_information": [ { "code": "62327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1297.25, "discounted_cash": 872.0, "minimum": 389.175, "maximum": 1297.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1297.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1297.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1297.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1297.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Eye Foreign Body Detect", "code_information": [ { "code": "70030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 339.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 202.72, "10th_percentile": 202.72, "90th_percentile": 202.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "82271 O BLD OCCULT OTHER (RH)", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.5, "discounted_cash": 5.0, "minimum": 5.17, "maximum": 43.164, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 103.0, "minimum": 103.15, "maximum": 1128.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 706.1, "10th_percentile": 706.1, "90th_percentile": 706.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 987.13, "10th_percentile": 808.03, "90th_percentile": 1710.26, "count": "11" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 849.46, "10th_percentile": 816.85, "90th_percentile": 948.82, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 805.5, "10th_percentile": 805.5, "90th_percentile": 853.8, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 832.19, "10th_percentile": 832.19, "90th_percentile": 832.19, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 853.8, "10th_percentile": 102.92, "90th_percentile": 1113.75, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FAC REPLNT THUMB AMPUTATION", "code_information": [ { "code": "20827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4360.5, "discounted_cash": 1586.0, "minimum": 1308.15, "maximum": 4360.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4360.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4360.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4360.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "29131 O APPLICATION FINGER SPLINT DYNAMIC (RH)", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.25, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 219.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 219.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 219.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med Occult Blood FIT, Stool", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.0, "discounted_cash": 15.0, "minimum": 15.4711, "maximum": 83.5354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 74.4, "10th_percentile": 74.4, "90th_percentile": 74.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 59.24, "10th_percentile": 59.24, "90th_percentile": 59.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 62.56, "10th_percentile": 62.56, "90th_percentile": 63.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 71.16, "10th_percentile": 71.16, "90th_percentile": 74.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.92, "10th_percentile": 15.92, "90th_percentile": 83.54, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Elbow Left w Contrast", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2214.75, "discounted_cash": 773.0, "minimum": 664.425, "maximum": 2214.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1413.89, "10th_percentile": 1413.89, "90th_percentile": 1413.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2214.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2214.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2214.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1635.65, "10th_percentile": 1635.65, "90th_percentile": 1635.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2158.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1834.69, "10th_percentile": 1612.93, "90th_percentile": 1834.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Diabetic Ed F/U 30 Min 2-4 ppl MCR", "code_information": [ { "code": "G0109", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.75, "discounted_cash": 15.0, "minimum": 14.888, "maximum": 66.054, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.61, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Physician/QHP OP Pulmonary Rehab W Monitor", "code_information": [ { "code": "94626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.25, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 209.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7323.0, "minimum": 6346.17, "maximum": 14911.232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 12148.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14911.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 11928.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9691.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6346.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7323.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9691.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7323.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9177.61 } ] } ] }, { "description": "36569 FAC INS PICC W/O PORT >5YRS", "code_information": [ { "code": "36569", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4909.25, "discounted_cash": 1553.0, "minimum": 1472.775, "maximum": 4909.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4909.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4909.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4909.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64605 O DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH (RH)", "code_information": [ { "code": "64605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3093.0, "discounted_cash": 1926.0, "minimum": 927.9, "maximum": 3093.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3093.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3093.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3093.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2100.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3093.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Pudendal Nerve Injection 64430", "code_information": [ { "code": "64430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2938.25, "discounted_cash": 872.0, "minimum": 182.4, "maximum": 2938.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2938.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2938.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2938.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "99285 - Level 5", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2545.75, "discounted_cash": 587.0, "minimum": 587.61, "maximum": 2545.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1487.64, "10th_percentile": 285.46, "90th_percentile": 1753.29, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2314.95, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2545.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2249.78, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 1880.99, "10th_percentile": 1880.99, "90th_percentile": 2219.9, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1720.97, "10th_percentile": 1720.97, "90th_percentile": 1941.64, "count": "65" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1951.57, "10th_percentile": 1697.06, "90th_percentile": 2841.21, "count": "72" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1753.29, "10th_percentile": 1487.64, "90th_percentile": 1998.41, "count": "17" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 640.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2219.89, "10th_percentile": 1697.06, "90th_percentile": 2219.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 993.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ropivacaine HCl Inj 2 MG/ML", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "25021067187", "type": "NDC" }, { "code": "J2795", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.84, "10th_percentile": 11.99, "90th_percentile": 35.84, "count": "13" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 35.84, "10th_percentile": 35.84, "90th_percentile": 37.78, "count": "1 through 10" } ] } ] }, { "description": "PARE BN HK LESION 2-4 FAC", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.0, "discounted_cash": 197.0, "minimum": 41.25, "maximum": 353.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "903", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9943.0, "minimum": 8437.79, "maximum": 21134.4849, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17218.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21134.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 16907.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17478.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8437.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9943.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17478.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9943.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13007.92 } ] } ] }, { "description": "OT Group Train WO Patient Unit", "code_information": [ { "code": "G0543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.5, "discounted_cash": 28.0, "minimum": 26.85, "maximum": 89.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "21550 O BIOPSY SOFT TISSUE NECK/THORAX (RH)", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1606.5, "discounted_cash": 1629.0, "minimum": 481.95, "maximum": 1606.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Multiple Level Spinal Fusion Except Cervical without MCC", "code_information": [ { "code": "448", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33300.0, "minimum": 28263.25, "maximum": 103549.2065, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 62431.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 76630.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 61304.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 90905.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28263.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 90906.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 33300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47164.82 } ] } ] }, { "description": "Neutral Fat, Fecal", "code_information": [ { "code": "82705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.75, "discounted_cash": 5.0, "minimum": 4.9562, "maximum": 123.606, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 22.8, "10th_percentile": 22.8, "90th_percentile": 22.8, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 5.1, "10th_percentile": 5.1, "90th_percentile": 5.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FINGER DISLOC ANES FAC", "code_information": [ { "code": "26775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1642.25, "discounted_cash": 275.0, "minimum": 275.97, "maximum": 2412.606, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1087.21, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1320.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1056.61, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "33231 FAC INS PULS GEN W/EX MULT LD", "code_information": [ { "code": "33231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95024.25, "discounted_cash": 30971.0, "minimum": 28507.275, "maximum": 95024.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95024.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95024.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95024.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33758.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52378.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11311 O SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM (RH)", "code_information": [ { "code": "11311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 363.75, "discounted_cash": 197.0, "minimum": 109.125, "maximum": 363.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 363.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 363.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 363.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Perc Tube-Catheter Change", "code_information": [ { "code": "75984", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1146.75, "minimum": 344.025, "maximum": 999.966, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 508.93 } ] } ] }, { "description": "TREAT HUMERUS/UPPR ARM/ ELBW FRACTURE FAC", "code_information": [ { "code": "24535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4744.75, "discounted_cash": 1586.0, "minimum": 1423.425, "maximum": 4744.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4744.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4744.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4744.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC PARTIAL REM FOOT FASCIA ASC", "code_information": [ { "code": "28060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "25622 O CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ (RH)", "code_information": [ { "code": "25622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2206.75, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 1924.286, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MTP DISLOC ANES FAC", "code_information": [ { "code": "28635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1642.25, "discounted_cash": 1586.0, "minimum": 492.675, "maximum": 1642.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1642.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1642.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1642.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1642.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1642.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Sacrum and Coccyx Min 2 Views", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 517.5, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 451.26, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 396.72, "10th_percentile": 374.29, "90th_percentile": 429.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 390.6, "10th_percentile": 390.6, "90th_percentile": 390.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 328.1, "10th_percentile": 328.1, "90th_percentile": 328.1, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 379.57, "10th_percentile": 379.57, "90th_percentile": 379.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 95.97, "10th_percentile": 95.97, "90th_percentile": 95.97, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HLA-B*57:01 for Abacavir Sensitivity", "code_information": [ { "code": "81381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 667.25, "discounted_cash": 169.0, "minimum": 165.1088, "maximum": 667.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.38, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 165.11, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "82962 O GLUCOSE BLD MNTR DV (RH)", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 3.0, "minimum": 3.1875, "maximum": 26.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FAC REPAIR LIP > HALF/CMPL", "code_information": [ { "code": "40654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2552.5, "discounted_cash": 1530.0, "minimum": 765.75, "maximum": 3944.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2552.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2552.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2552.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2552.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Imipramine Level", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "minimum": 26.236, "maximum": 154.344, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.24 } ] } ] }, { "description": "46945 O HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP (RH)", "code_information": [ { "code": "46945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2627.25, "discounted_cash": 2738.0, "minimum": 788.175, "maximum": 2627.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2627.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": ".Beta 2 Glycoprotein IgG", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.5, "discounted_cash": 25.0, "minimum": 24.7323, "maximum": 111.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 113.76, "10th_percentile": 113.76, "90th_percentile": 113.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 213.08, "10th_percentile": 213.08, "90th_percentile": 213.08, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 79.55, "10th_percentile": 76.44, "90th_percentile": 229.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 98.12, "10th_percentile": 98.12, "90th_percentile": 103.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Angio Neck w Contrast", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1744.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1647.3337, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1605.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Diabetic Ed Indiv 30 Min MCR", "code_information": [ { "code": "G0108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.75, "discounted_cash": 53.0, "minimum": 22.725, "maximum": 75.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.82, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 50.63, "10th_percentile": 49.55, "90th_percentile": 101.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36556 O INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> (RH)", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 661.25, "discounted_cash": 3115.0, "minimum": 198.375, "maximum": 2773.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PT Mechanical Traction Units", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.5, "discounted_cash": 13.0, "minimum": 13.372, "maximum": 95.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Alpha-1 Globulins", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.5, "discounted_cash": 10.0, "minimum": 10.4371, "maximum": 200.124, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.35, "10th_percentile": 10.74, "90th_percentile": 201.96, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 154.22, "10th_percentile": 146.83, "90th_percentile": 183.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 146.19, "10th_percentile": 146.19, "90th_percentile": 146.19, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 154.38, "10th_percentile": 146.99, "90th_percentile": 157.35, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 48.01, "10th_percentile": 48.01, "90th_percentile": 48.01, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "11301 O SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM (RH)", "code_information": [ { "code": "11301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.5, "discounted_cash": 197.0, "minimum": 76.95, "maximum": 256.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 256.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 256.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 256.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR VCUG in Radiology", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 776.25, "discounted_cash": 235.0, "minimum": 232.875, "maximum": 776.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 776.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 776.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 776.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 776.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "675", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13531.0, "minimum": 10833.96, "maximum": 41390.2997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 24163.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29659.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 23727.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32995.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10833.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13531.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32995.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13531.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18255.13 } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [ { "code": "369", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8654.0, "minimum": 7043.15, "maximum": 24572.3738, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14724.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18073.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14458.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15921.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7043.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8654.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15921.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8654.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11123.9 } ] } ] }, { "description": "Hepatitis A Antibodies,Total", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.5, "discounted_cash": 12.0, "minimum": 12.0406, "maximum": 129.492, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 55.38, "10th_percentile": 55.38, "90th_percentile": 55.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 89.18, "10th_percentile": 89.18, "90th_percentile": 89.18, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 99.9, "10th_percentile": 95.98, "90th_percentile": 99.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 65.01, "10th_percentile": 12.39, "90th_percentile": 129.49, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Hida Scan", "code_information": [ { "code": "78226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.0, "discounted_cash": 394.0, "minimum": 391.5, "maximum": 1305.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1305.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1305.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1305.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1010.98, "10th_percentile": 1010.98, "90th_percentile": 1010.98, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1148.4, "10th_percentile": 1148.4, "90th_percentile": 1148.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TX FX GREAT TOE FAC", "code_information": [ { "code": "28490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.25, "discounted_cash": 243.0, "minimum": 100.275, "maximum": 990.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 334.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 334.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 334.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "167", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14763.0, "minimum": 12646.65, "maximum": 54188.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 26548.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32587.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 26069.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36537.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12646.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14763.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36537.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 54188.9, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 17055.49, "10th_percentile": 17055.49, "90th_percentile": 17055.49, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14763.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20056.84 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [ { "code": "543", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8866.0, "minimum": 7342.84, "maximum": 25616.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15133.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18575.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14860.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25616.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7342.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25616.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8866.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11433.09 } ] } ] }, { "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": 21740.0, "minimum": 19703.64, "maximum": 85880.6605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 77312.29, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 79134.07, "10th_percentile": 79134.07, "90th_percentile": 79134.07, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 40054.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 49164.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 39331.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56426.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19703.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21740.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56426.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 21740.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30259.87 } ] } ] }, { "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": 11360.0, "minimum": 7652.22, "maximum": 41213.2488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19962.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24502.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 19602.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29675.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7652.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29675.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15081.0 } ] } ] }, { "description": "Adenovirus", "code_information": [ { "code": "87633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 396.5, "discounted_cash": 416.0, "minimum": 118.95, "maximum": 396.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 299.2, "10th_percentile": 251.33, "90th_percentile": 299.2, "count": "25" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 266.73, "10th_percentile": 256.41, "90th_percentile": 266.73, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 396.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 374.0, "10th_percentile": 299.2, "90th_percentile": 396.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 374.0, "10th_percentile": 374.0, "90th_percentile": 374.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 396.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14029.0, "minimum": 10912.86, "maximum": 36915.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 25128.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30843.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 24674.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36915.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10912.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36915.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28555.03, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9119.18, "10th_percentile": 9119.18, "90th_percentile": 33657.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18983.6 } ] } ] }, { "description": "XR Hand Left AP+Lateral", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.75, "discounted_cash": 103.0, "minimum": 73.125, "maximum": 243.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 212.55, "10th_percentile": 212.55, "90th_percentile": 212.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 243.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 243.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "33218 FAC PACER LEAD REPAIR SINGLE", "code_information": [ { "code": "33218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6048.25, "discounted_cash": 3687.0, "minimum": 1814.475, "maximum": 6048.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6048.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "15852 O DRESSING CHANGE UNDER ANESTHESIA (RH)", "code_information": [ { "code": "15852", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.25, "discounted_cash": 729.0, "minimum": 120.975, "maximum": 403.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LAC VEST MOUTH <2.5 FAC", "code_information": [ { "code": "40830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 233.0, "minimum": 75.0, "maximum": 250.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 250.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 250.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 250.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR FINGER TENDON WO GRAFT ASC", "code_information": [ { "code": "26433", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2430.75, "discounted_cash": 3228.0, "minimum": 729.225, "maximum": 2430.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Oxalic Acid/Creat Ratio", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.25, "discounted_cash": 14.0, "minimum": 14.0425, "maximum": 147.586, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "96374 IV PUSH INITIAL/SINGLE INH/INJ - AMB INJ (RH)", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.75, "discounted_cash": 209.0, "minimum": 95.925, "maximum": 506.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 340.37, "10th_percentile": 340.37, "90th_percentile": 405.2, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 374.24, "10th_percentile": 374.24, "90th_percentile": 441.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 300.7, "10th_percentile": 247.61, "90th_percentile": 300.7, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 397.6, "10th_percentile": 313.8, "90th_percentile": 401.15, "count": "16" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 441.67, "10th_percentile": 441.67, "90th_percentile": 445.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Cardiac w+wo 75561", "code_information": [ { "code": "75561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1654.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1654.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1111.82, "10th_percentile": 1111.82, "90th_percentile": 1111.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1261.89, "10th_percentile": 1261.89, "90th_percentile": 1286.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1654.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 966.5, "10th_percentile": 966.5, "90th_percentile": 966.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 345.64, "10th_percentile": 345.64, "90th_percentile": 1442.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Panc Mass Protocol abd only", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3122.5, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2722.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1787.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REMOVAL OF SUPPORT IMPLANT ASC", "code_information": [ { "code": "20680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3434.5, "discounted_cash": 2866.0, "minimum": 1030.35, "maximum": 3434.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2177.28, "10th_percentile": 1655.64, "90th_percentile": 7594.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3434.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3434.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3434.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 2619.49, "10th_percentile": 2619.49, "90th_percentile": 2619.49, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2988.02, "10th_percentile": 2818.8, "90th_percentile": 3013.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3434.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "38500 O BX/EXC LYMPH NODE OPEN SUPERFICIAL (RH)", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2217.0, "discounted_cash": 3863.0, "minimum": 665.1, "maximum": 2217.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2217.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REPAIR LIP < = HALF FAC", "code_information": [ { "code": "40652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3213.25, "discounted_cash": 532.0, "minimum": 532.15, "maximum": 2973.084, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2096.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2546.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2037.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "C9766 FAC REVASC INTRA LITHOTRIP ATHER", "code_information": [ { "code": "C9766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56815.25, "discounted_cash": 18087.0, "minimum": 17044.575, "maximum": 56815.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56815.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56815.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56815.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR OF KNECAP TENDON ASC", "code_information": [ { "code": "27380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10420.25, "discounted_cash": 7159.0, "minimum": 3126.075, "maximum": 10420.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10420.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10420.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10420.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 3821.12, "10th_percentile": 3821.12, "90th_percentile": 3821.12, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10420.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Covid-19 Ag", "code_information": [ { "code": "87811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 41.0, "minimum": 14.175, "maximum": 50.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 33.64, "10th_percentile": 33.64, "90th_percentile": 33.64, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 41.58, "10th_percentile": 41.58, "90th_percentile": 41.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Transrectal", "code_information": [ { "code": "76872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 624.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Strep pneumoniae 7F IgG", "code_information": [ { "code": "86317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 14.0, "minimum": 10.8, "maximum": 91.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11310 O SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/< (RH)", "code_information": [ { "code": "11310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.25, "discounted_cash": 197.0, "minimum": 81.075, "maximum": 270.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 270.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93642 FAC EP EVAL PACER / ICD", "code_information": [ { "code": "93642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5150.75, "discounted_cash": 1201.0, "minimum": 1201.34, "maximum": 5150.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4599.57, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2031.71, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4732.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5150.75, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "Lidocaine HCl Local Inj 1%", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409427616", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "64484 O INJ LB/SAC EA+ (RH)", "code_information": [ { "code": "64484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 529.0, "minimum": 158.7, "maximum": 2567.822, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 1995.15, "90th_percentile": 1995.15, "count": "1 through 10" } ] } ] }, { "description": "28193 O REMOVAL FOREIGN BODY FOOT COMPLICATED (RH)", "code_information": [ { "code": "28193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3011.5, "discounted_cash": 1629.0, "minimum": 903.45, "maximum": 3011.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3011.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3011.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3011.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "28600 O CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES (RH)", "code_information": [ { "code": "28600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1516.75, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 1322.606, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "46230 O EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS (RH)", "code_information": [ { "code": "46230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1682.25, "discounted_cash": 2738.0, "minimum": 504.675, "maximum": 1682.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1682.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "88334 AP Bill Cytologic Exam Additional Site", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.5, "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": "NM Bone Scan 3 Phase", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1415.25, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1415.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1415.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1415.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1415.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1415.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "49180 O PERCUT NEEDLE BX ABDOMINAL MASS (RH)", "code_information": [ { "code": "49180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 730.25, "discounted_cash": 1629.0, "minimum": 219.075, "maximum": 1527.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1198.89, "10th_percentile": 1198.89, "90th_percentile": 1198.89, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 730.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC EXPLORE WOUND EXTREMITY ASC", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2027.0, "discounted_cash": 1629.0, "minimum": 527.925, "maximum": 2796.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2027.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37256 REVASC EVASC IVT ANGIO CPLX 1st FAC", "code_information": [ { "code": "37256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22038.25, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 22038.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22038.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22038.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38479.0, "minimum": 34862.05, "maximum": 104989.1394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 72454.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 88934.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 71147.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 96844.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34862.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38479.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 96844.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 38479.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54737.57 } ] } ] }, { "description": "95813 O ELECTROENCEPHALOGRAM EXTND MNTR >1 HR (RH)", "code_information": [ { "code": "95813", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1681.25, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1466.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 10192.0, "minimum": 8200.39, "maximum": 21725.3686, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17699.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21725.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 17380.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9718.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8200.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10192.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9718.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10192.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13371.6 } ] } ] }, { "description": "28011 O TENOTOMY TOE MULT TENDON (RH)", "code_information": [ { "code": "28011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2498.5, "discounted_cash": 1586.0, "minimum": 749.55, "maximum": 2498.5, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2498.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2498.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2498.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2498.5, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "NM Cisternogram", "code_information": [ { "code": "78630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1027.0, "discounted_cash": 535.0, "minimum": 308.1, "maximum": 1027.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1027.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1027.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1027.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1027.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Abdomen Complete", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 975.332, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 844.2, "10th_percentile": 844.2, "90th_percentile": 844.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 820.35, "10th_percentile": 820.35, "90th_percentile": 820.35, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 690.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 305.48, "10th_percentile": 305.48, "90th_percentile": 844.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 975.33, "10th_percentile": 102.92, "90th_percentile": 975.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "52352 O CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES (RH)", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2985.75, "discounted_cash": 3478.0, "minimum": 895.725, "maximum": 2985.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2985.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 28.0, "minimum": 25.05, "maximum": 83.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 83.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Myoview", "code_information": [ { "code": "A9502", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 367.5, "minimum": 110.25, "maximum": 320.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 233.02, "10th_percentile": 233.02, "90th_percentile": 233.02, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 280.4, "10th_percentile": 280.4, "90th_percentile": 280.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 280.29, "10th_percentile": 269.56, "90th_percentile": 280.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.01 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 274.63, "10th_percentile": 274.63, "90th_percentile": 288.49, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 281.73, "10th_percentile": 265.82, "90th_percentile": 320.46, "count": "1 through 10" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [ { "code": "552", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8359.0, "minimum": 6670.78, "maximum": 23208.2405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14151.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17370.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13896.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14115.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6670.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14115.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8359.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10691.27 } ] } ] }, { "description": "97606 NEGATIVE PRESSURE WOUND TX >50 SQ CM", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 655.75, "discounted_cash": 401.0, "minimum": 40.725, "maximum": 655.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 655.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 655.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 655.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 655.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 120 MG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00548560600", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "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": 55309.0, "minimum": 53114.4, "maximum": 154297.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 105032.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 128921.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 103136.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 154297.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54867.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 154297.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 55309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79348.74 } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [ { "code": "279", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28476.0, "minimum": 22178.71, "maximum": 72359.9639, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 53091.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 65167.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 52133.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47021.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22178.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28476.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47021.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 28476.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40109.23 } ] } ] }, { "description": "Theo", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.25, "discounted_cash": 14.0, "minimum": 13.7413, "maximum": 134.506, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Entire Upper Extrem LT WO Contrast", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1503.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1311.052, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 433.55, "10th_percentile": 433.55, "90th_percentile": 433.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1041.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 433.55, "10th_percentile": 433.55, "90th_percentile": 456.02, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 102.92, "10th_percentile": 102.92, "90th_percentile": 983.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "15934 O EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR (RH)", "code_information": [ { "code": "15934", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7093.25, "discounted_cash": 3496.0, "minimum": 2127.975, "maximum": 7093.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7093.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7093.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7093.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3811.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5913.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "42809 O REMOVAL FOREIGN BODY PHARYNX (RH)", "code_information": [ { "code": "42809", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1199.0, "discounted_cash": 440.0, "minimum": 78.225, "maximum": 1199.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1199.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1199.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1199.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 745.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "595", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17176.0, "minimum": 14639.31, "maximum": 38320.7097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 31219.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38320.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 30656.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28703.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14639.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28703.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 17176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23585.75 } ] } ] }, { "description": "DIST FINGER FX MANI FAC", "code_information": [ { "code": "26755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.5, "discounted_cash": 243.0, "minimum": 124.05, "maximum": 413.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 413.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 413.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 413.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "$ Streptozyme Titer", "code_information": [ { "code": "86406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.5, "discounted_cash": 10.0, "minimum": 10.34, "maximum": 68.452, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hepatitis C Antibody, IgG", "code_information": [ { "code": "86803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.25, "discounted_cash": 14.0, "minimum": 13.8676, "maximum": 184.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 159.4, "10th_percentile": 63.79, "90th_percentile": 159.4, "count": "29" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.33, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 126.92, "10th_percentile": 37.89, "90th_percentile": 184.21, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 142.11, "10th_percentile": 136.61, "90th_percentile": 142.11, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 63.79, "10th_percentile": 63.79, "90th_percentile": 63.79, "count": "13" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 175.34, "10th_percentile": 175.34, "90th_percentile": 175.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7505.0, "minimum": 5960.65, "maximum": 20419.3057, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 12498.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15341.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 12273.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12266.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5960.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7505.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12266.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7505.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9442.31 } ] } ] }, { "description": "Alcohol, Isopropyl", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.0, "minimum": 30.0, "maximum": 812.704, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.82 } ] } ] }, { "description": "IGF-1 (Insulin-Like Growth Factor 1)", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 21.0, "minimum": 20.6605, "maximum": 177.888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 163.2, "10th_percentile": 163.2, "90th_percentile": 163.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 129.95, "10th_percentile": 129.95, "90th_percentile": 129.95, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 139.86, "10th_percentile": 137.23, "90th_percentile": 139.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 95.03, "10th_percentile": 95.03, "90th_percentile": 95.03, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 21.26, "10th_percentile": 21.26, "90th_percentile": 179.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 401.0, "minimum": 167.625, "maximum": 1919.5443, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1782) MORCELLATOR", "code_information": [ { "code": "C1782", "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": 76.66, "median_amount": 1768.16, "10th_percentile": 1768.16, "90th_percentile": 2831.25, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL C1874) STENT COATED/COVR W/DELIVERY SYSTEM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1161.59, "10th_percentile": 1161.59, "90th_percentile": 1161.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2656.11, "10th_percentile": 2656.11, "90th_percentile": 22398.63, "count": "1 through 10" } ] } ] }, { "description": "Stool, Occult Blood, 3 Screening Samples MCR MCR", "code_information": [ { "code": "G0328", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.5, "discounted_cash": 18.0, "minimum": 17.541, "maximum": 60.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "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": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LAC FACE 2.6-5CM FAC", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 197.0, "minimum": 119.4, "maximum": 473.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 398.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 398.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 571.37, "10th_percentile": 571.37, "90th_percentile": 571.37, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 347.06, "10th_percentile": 347.06, "90th_percentile": 347.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8673.0, "minimum": 7447.35, "maximum": 19949.895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14761.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18118.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14494.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17451.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7447.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8673.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17451.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8673.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11151.71 } ] } ] }, { "description": "11622 O EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM (RH)", "code_information": [ { "code": "11622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1092.25, "discounted_cash": 698.0, "minimum": 327.675, "maximum": 1092.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1092.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC EXPLORE TREAT WRIST JOINT ASC", "code_information": [ { "code": "25101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [ { "code": "659", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20372.0, "minimum": 17886.79, "maximum": 51123.8377, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 37405.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 45913.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 36730.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34577.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17886.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34577.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 51123.84, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 27150.1, "10th_percentile": 27150.1, "90th_percentile": 27150.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 20372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28259.08 } ] } ] }, { "description": "17110 O DESTRUCTION BENIGN LESIONS UP TO 14 (RH)", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 684.5, "discounted_cash": 197.0, "minimum": 179.175, "maximum": 684.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 684.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 684.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 684.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 192.31, "10th_percentile": 192.31, "90th_percentile": 192.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC CARPAL TUNNEL SURGERY ASC", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2664.5, "discounted_cash": 1926.0, "minimum": 799.35, "maximum": 4346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1985.86, "10th_percentile": 1985.86, "90th_percentile": 1985.86, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2664.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2664.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2664.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1954.19, "10th_percentile": 1954.19, "90th_percentile": 2032.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 2054.03, "10th_percentile": 1027.02, "90th_percentile": 2054.03, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1985.86, "10th_percentile": 1985.86, "90th_percentile": 1985.86, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2100.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2477.99, "10th_percentile": 2477.99, "90th_percentile": 3717.21, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2664.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "15004 O PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT (RH)", "code_information": [ { "code": "15004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2399.75, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 2092.582, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1919.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "29280 O STRAPPING HAND/FINGER (RH)", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.75, "discounted_cash": 58.0, "minimum": 45.225, "maximum": 255.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 150.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 150.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REHABILITATION WITH CCMCC", "code_information": [ { "code": "945", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12825.0, "minimum": 10565.41, "maximum": 33490.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22797.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27982.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 22386.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33490.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10565.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33490.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17223.03 } ] } ] }, { "description": ".JAK2 Exons 12, 13 Mutations, Qual", "code_information": [ { "code": "81403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1863.75, "discounted_cash": 185.0, "minimum": 179.9774, "maximum": 1625.19, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 313.21, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 224.96, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 179.98, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 971.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Urinalysis with Sediment Exam", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.25, "discounted_cash": 3.0, "minimum": 3.0806, "maximum": 50.794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 46.6, "10th_percentile": 39.14, "90th_percentile": 46.6, "count": "65" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.08, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 37.11, "10th_percentile": 37.11, "90th_percentile": 37.11, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.94, "10th_percentile": 39.94, "90th_percentile": 39.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.17, "10th_percentile": 14.17, "90th_percentile": 46.6, "count": "26" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 50.79, "10th_percentile": 16.63, "90th_percentile": 50.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 85.0, "minimum": 85.87, "maximum": 345.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 260.4, "10th_percentile": 260.4, "90th_percentile": 260.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 345.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 218.73, "10th_percentile": 34.35, "90th_percentile": 218.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 253.04, "10th_percentile": 253.04, "90th_percentile": 263.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 324.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 146.17, "10th_percentile": 146.17, "90th_percentile": 146.17, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 264.48, "10th_percentile": 34.09, "90th_percentile": 300.84, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Elbow Left w Contrast", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1606.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1606.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1606.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1330.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Ribs Bilateral wo Chest Film", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 551.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VEEG 2-12 Hr Continuous Monitor", "code_information": [ { "code": "95713", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1663.0, "discounted_cash": 368.0, "minimum": 368.19, "maximum": 1663.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1450.52, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1409.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 78.5, "median_amount": 43.31, "10th_percentile": 43.31, "90th_percentile": 159.45, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 53.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "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": 14190.0, "minimum": 12271.52, "maximum": 43551.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 25438.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31224.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 24979.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43551.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12271.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14190.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43551.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14190.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19218.26 } ] } ] }, { "description": "Vent Assist Hospital Initial", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 835.5, "discounted_cash": 609.0, "minimum": 250.65, "maximum": 835.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 835.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 835.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 835.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 664.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 835.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "33244 FAC DEFIB TRANSVENOUS REMOVAL", "code_information": [ { "code": "33244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7044.0, "discounted_cash": 3687.0, "minimum": 2113.2, "maximum": 7044.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7044.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7044.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7044.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "88311 AP Bill Decalcification", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.0, "minimum": 33.6, "maximum": 97.664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 75.26, "10th_percentile": 75.26, "90th_percentile": 75.26, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 76.79, "10th_percentile": 76.79, "90th_percentile": 76.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.17, "10th_percentile": 56.17, "90th_percentile": 56.17, "count": "1 through 10" } ] } ] }, { "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": 17839.0, "minimum": 15851.92, "maximum": 49817.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 32503.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39896.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 31917.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49817.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15851.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17839.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49817.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 17839.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24555.56 } ] } ] }, { "description": "U ALA", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 16.0, "minimum": 15.9861, "maximum": 138.43, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.99, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "20205 O BX MUSCLE DEEP (RH)", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1353.75, "discounted_cash": 2866.0, "minimum": 406.125, "maximum": 1353.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1353.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CTA Head + Neck w+wo Contrast 70471", "code_information": [ { "code": "70471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1351.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1351.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1351.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1351.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [ { "code": "506", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11309.0, "minimum": 10375.77, "maximum": 29178.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19862.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24379.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 19503.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29178.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10375.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11309.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29178.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11309.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15005.37 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5185.0, "minimum": 3787.35, "maximum": 12090.2547, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 10884.0, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6877.12, "10th_percentile": 6877.12, "90th_percentile": 6877.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 8008.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 9829.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 7863.99 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 10574.81, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4377.1, "10th_percentile": 4377.1, "90th_percentile": 4377.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8814.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3787.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5185.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8814.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 5185.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6050.19 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35627.0, "minimum": 30954.26, "maximum": 82417.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 66934.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 82158.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 65726.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 82417.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30954.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35627.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 82417.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 35627.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50566.94 } ] } ] }, { "description": "INS TEMP BLADDER CATHETER FAC", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.5, "discounted_cash": 131.0, "minimum": 78.825, "maximum": 391.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 391.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 391.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 391.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 328.02, "10th_percentile": 328.02, "90th_percentile": 341.39, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14352.0, "minimum": 11401.51, "maximum": 37831.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 25752.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31609.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 25287.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37831.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11401.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14352.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37831.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14352.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19455.15 } ] } ] }, { "description": "96160 O PT-FOCUSED HLTH RISK ASSMT MCR (RH)", "code_information": [ { "code": "G0444", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.75, "discounted_cash": 36.0, "minimum": 29.925, "maximum": 99.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 99.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 28.83, "10th_percentile": 28.83, "90th_percentile": 28.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TX STERNUM FX FAC", "code_information": [ { "code": "21820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.5, "discounted_cash": 243.0, "minimum": 65.55, "maximum": 218.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36730.0, "minimum": 32903.31, "maximum": 111949.2231, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 69070.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 84780.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 67824.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 95342.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32903.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36730.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 95342.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 36730.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52180.7 } ] } ] }, { "description": "$ AP 88321 Consult", "code_information": [ { "code": "88321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1095.25, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 955.058, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 626.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Pyelogram Retrograde", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1540.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1540.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 976.25, "10th_percentile": 976.25, "90th_percentile": 976.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1540.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 473.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1113.68, "10th_percentile": 1113.68, "90th_percentile": 1180.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Remove Contraceptive Capsule 11976", "code_information": [ { "code": "11976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1863.0, "discounted_cash": 698.0, "minimum": 180.825, "maximum": 1863.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1863.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1863.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1863.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC ARTHRO KNEE W MENISCUS RPR MEDIAL LATERAL ASC", "code_information": [ { "code": "29883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1653.14, "10th_percentile": 1653.14, "90th_percentile": 1653.14, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Renal Scan w Pharm Single", "code_information": [ { "code": "78708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1188.25, "discounted_cash": 535.0, "minimum": 356.475, "maximum": 1188.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 475.03, "10th_percentile": 475.03, "90th_percentile": 475.03, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1188.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1188.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1188.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1053.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 520.96, "10th_percentile": 520.96, "90th_percentile": 520.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Clozapine & Metabolites Quantitative", "code_information": [ { "code": "80159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.25, "discounted_cash": 20.0, "minimum": 19.5818, "maximum": 85.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.58, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Angio Head wo Contrast", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1925.5, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1679.036, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1468.58, "10th_percentile": 1468.58, "90th_percentile": 1468.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1453.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 233.95, "10th_percentile": 233.95, "90th_percentile": 1476.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "24075 O EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM (RH)", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3121.75, "discounted_cash": 1629.0, "minimum": 608.1, "maximum": 3121.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1510.68, "10th_percentile": 1510.68, "90th_percentile": 3021.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3121.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3121.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3121.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med CONTRACT RATE Hepatitis B Vaccine", "code_information": [ { "code": "90739", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.0, "minimum": 48.0, "maximum": 160.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 382.05, "10th_percentile": 382.05, "90th_percentile": 382.05, "count": "1 through 10" } ] } ] }, { "description": "I-D HEMATOMA FLUID FAC", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 896.5, "discounted_cash": 1629.0, "minimum": 162.075, "maximum": 896.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 751.3, "10th_percentile": 751.3, "90th_percentile": 751.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 896.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Cistenal-Lat Cerv Puncture w Inject", "code_information": [ { "code": "61055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 881.25, "discounted_cash": 302.0, "minimum": 264.375, "maximum": 881.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 881.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 881.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 881.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "97530 O THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN (RH)", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.75, "discounted_cash": 33.0, "minimum": 32.3998, "maximum": 228.246, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 217.73, "10th_percentile": 217.73, "90th_percentile": 217.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Biliary Unlisted 47999", "code_information": [ { "code": "47999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2754.25, "discounted_cash": 894.0, "minimum": 826.275, "maximum": 2754.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2754.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2754.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2754.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17770.0, "minimum": 15629.75, "maximum": 53311.9327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 32368.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39730.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 31784.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46495.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15629.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17770.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46495.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 17770.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24453.24 } ] } ] }, { "description": "IR Replace Tunneled CVAD w Port", "code_information": [ { "code": "36582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7169.75, "discounted_cash": 3115.0, "minimum": 2150.925, "maximum": 7169.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7169.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7169.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7169.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Insulin Antibody", "code_information": [ { "code": "86337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.5, "discounted_cash": 21.0, "minimum": 20.8062, "maximum": 279.476, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR OF THIGH MUSCLE ASC", "code_information": [ { "code": "27385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10420.25, "discounted_cash": 7159.0, "minimum": 3126.075, "maximum": 10420.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6606.1, "10th_percentile": 6606.1, "90th_percentile": 6606.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10420.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10420.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10420.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10420.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [ { "code": "335", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28206.0, "minimum": 25078.75, "maximum": 88035.8246, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 52569.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64525.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 51620.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 53117.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25078.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53117.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 28206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39714.41 } ] } ] }, { "description": "52287 O CHMDNRV INJ BLDDR (RH)", "code_information": [ { "code": "52287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1524.5, "discounted_cash": 2062.0, "minimum": 457.35, "maximum": 1524.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1982.63, "10th_percentile": 1982.63, "90th_percentile": 2062.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1524.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6283.0, "minimum": 4759.8, "maximum": 12439.2779, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 10134.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12439.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 9951.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8874.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4759.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6283.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8874.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6283.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7656.16 } ] } ] }, { "description": "27347 O EXCISION LESION MENISCUS/CAPSULE KNEE (RH)", "code_information": [ { "code": "27347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3421.75, "discounted_cash": 3228.0, "minimum": 1026.525, "maximum": 3421.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3421.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3421.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3421.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3421.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3421.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "12041 O REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< (RH)", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1539.0, "discounted_cash": 401.0, "minimum": 167.625, "maximum": 1539.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1539.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1539.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NASAL BONE FX STABIL FAC", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 627.75, "discounted_cash": 3271.0, "minimum": 188.325, "maximum": 1039.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC INJ TRIGGER POINT 1 OR 2 MUSCL ASC", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1345.25, "discounted_cash": 302.0, "minimum": 99.6, "maximum": 1345.25, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1193.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1345.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1159.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1180.17, "10th_percentile": 1180.17, "90th_percentile": 1180.17, "count": "1 through 10" } ] } ] }, { "description": "20610 O ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA (RH)", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.75, "discounted_cash": 302.0, "minimum": 86.025, "maximum": 1518.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1297.77, "10th_percentile": 1297.77, "90th_percentile": 1297.77, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1889.09, "10th_percentile": 1889.09, "90th_percentile": 1889.09, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 171.42, "10th_percentile": 114.28, "90th_percentile": 171.42, "count": "61" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 286.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRIM NONDYSTRO NAILS FAC", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.0, "discounted_cash": 58.0, "minimum": 15.525, "maximum": 112.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [ { "code": "327", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19637.0, "minimum": 16805.68, "maximum": 58565.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 35982.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44166.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 35333.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58565.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16805.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19637.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58565.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 19637.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27183.61 } ] } ] }, { "description": "US Pelvis Complete", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 944.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 823.604, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 598.75, "10th_percentile": 598.75, "90th_percentile": 598.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 823.61, "10th_percentile": 823.61, "90th_percentile": 823.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 692.66, "10th_percentile": 692.66, "90th_percentile": 720.37, "count": "26" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 643.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 285.72, "10th_percentile": 285.72, "90th_percentile": 298.46, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 823.6, "10th_percentile": 823.6, "90th_percentile": 823.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chemo IV Push Each Addl Subsequent", "code_information": [ { "code": "96411", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.0, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 288.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 226.08, "10th_percentile": 217.21, "90th_percentile": 434.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 288.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 210.24, "10th_percentile": 210.24, "90th_percentile": 210.24, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 251.14, "10th_percentile": 220.78, "90th_percentile": 724.02, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "15271 O APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25 (RH)", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1191.75, "discounted_cash": 729.0, "minimum": 357.525, "maximum": 1191.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1191.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1191.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1191.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1191.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXC NAIL MATRIX FAC", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1901.5, "discounted_cash": 401.0, "minimum": 91.275, "maximum": 1901.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1901.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12491.0, "minimum": 10303.78, "maximum": 33663.8303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22151.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27189.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21751.73 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 29444.27, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18559.86, "10th_percentile": 18559.86, "90th_percentile": 18559.86, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30080.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10303.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12491.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30080.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12491.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16734.79 } ] } ] }, { "description": "XR Arthrogram TMJ", "code_information": [ { "code": "70332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1117.0, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1117.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1117.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 503.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27321.0, "minimum": 23802.45, "maximum": 83714.8144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 50856.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 62424.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 49939.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51023.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23802.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27321.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51023.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 27321.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38420.96 } ] } ] }, { "description": "TX METATAR FX MANI FAC", "code_information": [ { "code": "28475", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.25, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 323.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5613.0, "minimum": 4204.02, "maximum": 18589.9217, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 8837.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10847.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 8677.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 16310.95, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5238.73, "10th_percentile": 5238.73, "90th_percentile": 5238.73, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8551.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4204.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5613.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8551.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 5613.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6676.34 } ] } ] }, { "description": "KIDNEY TRANSPLANT", "code_information": [ { "code": "652", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25609.0, "minimum": 21258.17, "maximum": 71093.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 47543.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58356.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 46685.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71093.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21258.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71093.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 25609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35917.47 } ] } ] }, { "description": "Procalcitonin", "code_information": [ { "code": "86352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.75, "discounted_cash": 135.0, "minimum": 103.125, "maximum": 343.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 217.9, "10th_percentile": 217.9, "90th_percentile": 217.9, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 165.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 132.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 222.31, "10th_percentile": 222.31, "90th_percentile": 231.24, "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": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 343.75, "10th_percentile": 343.75, "90th_percentile": 343.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 285.34, "10th_percentile": 285.34, "90th_percentile": 285.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Peripheral Vascular Pulmonary Rehab", "code_information": [ { "code": "93668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.0, "discounted_cash": 58.0, "minimum": 55.8, "maximum": 186.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 186.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 186.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "$ Clostridum difficile A+B", "code_information": [ { "code": "87324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 188.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Breast Right Limited", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.75, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 465.0777, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 353.4, "10th_percentile": 296.86, "90th_percentile": 353.4, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 296.87, "10th_percentile": 296.87, "90th_percentile": 296.87, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 343.42, "10th_percentile": 343.42, "90th_percentile": 357.13, "count": "44" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.87, "10th_percentile": 132.89, "90th_percentile": 413.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 388.74, "10th_percentile": 85.22, "90th_percentile": 408.31, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Mastoids 1-2 Views Ea Side", "code_information": [ { "code": "70120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 485.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 485.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 485.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8767.0, "minimum": 7059.06, "maximum": 23639.5761, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14942.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18340.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14672.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19078.21 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 23585.36, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13712.97, "10th_percentile": 13712.97, "90th_percentile": 13712.97, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7059.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8767.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19078.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 23639.58, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8449.94, "10th_percentile": 8449.94, "90th_percentile": 8449.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8767.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11288.51 } ] } ] }, { "description": "HC (SUP SHELL C1766) INTRO/SHEATH,STRBLE,NON-PEEL", "code_information": [ { "code": "C1766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2485.9, "10th_percentile": 2485.9, "90th_percentile": 2485.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3062.76, "10th_percentile": 3062.76, "90th_percentile": 3062.76, "count": "1 through 10" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13189.0, "minimum": 10883.1, "maximum": 32334.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 23501.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28846.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 23077.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32334.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10883.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13189.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32334.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13189.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17754.65 } ] } ] }, { "description": "11400 FAC EXC BN LS TR<.5CM", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2051.75, "discounted_cash": 698.0, "minimum": 169.95, "maximum": 2051.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2051.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2051.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2051.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36252 FAC ANGIOGR RENAL 1ST OR BILA", "code_information": [ { "code": "36252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7231.25, "discounted_cash": 3115.0, "minimum": 2169.375, "maximum": 7231.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7231.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "423", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32633.0, "minimum": 28151.82, "maximum": 218868.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 61138.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75044.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 60035.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 218867.53 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28151.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32633.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 218868.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 32633.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46188.34 } ] } ] }, { "description": "CT Head w+wo Contrast", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2254.5, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1965.924, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 229.98, "10th_percentile": 229.98, "90th_percentile": 229.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1038.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11306 O SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM (RH)", "code_information": [ { "code": "11306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.5, "discounted_cash": 197.0, "minimum": 83.25, "maximum": 277.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 277.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 277.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 277.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 277.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Unlisted Dx Resp Procedure", "code_information": [ { "code": "78599", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 904.5, "discounted_cash": 394.0, "minimum": 271.35, "maximum": 904.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 904.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 904.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 904.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med Coronary Risk Panel", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 13.0, "minimum": 12.0, "maximum": 172.656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.4, "10th_percentile": 125.5, "90th_percentile": 149.4, "count": "257" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 121.03, "10th_percentile": 34.09, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 127.81, "10th_percentile": 122.89, "90th_percentile": 133.19, "count": "404" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.85, "10th_percentile": 59.85, "90th_percentile": 143.4, "count": "126" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 157.74, "10th_percentile": 70.26, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Up to 0.5 MG DIGOXIN - AMB DIGOXIN (RH)", "code_information": [ { "code": "J1160", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.25, "minimum": 10.492, "maximum": 38.586, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.49 } ] } ] }, { "description": "93620 FAC EP COMP W/ INDUCTION", "code_information": [ { "code": "93620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17971.75, "discounted_cash": 7695.0, "minimum": 5391.525, "maximum": 17971.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17971.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17971.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17971.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8388.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13015.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19751.0, "minimum": 16186.22, "maximum": 54457.6128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 36203.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44437.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 35549.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41906.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16186.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19751.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41907.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 19751.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27350.44 } ] } ] }, { "description": "32552 O REMOVAL PLEURAL CATHETER (RH)", "code_information": [ { "code": "32552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1358.5, "discounted_cash": 618.0, "minimum": 407.55, "maximum": 1475.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1358.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1358.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1358.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37269 REVSC EVASC FPVT ST CPLX 1st FAC", "code_information": [ { "code": "37269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44700.25, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 44700.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44700.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44700.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CCMCC", "code_information": [ { "code": "735", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11281.0, "minimum": 8401.8, "maximum": 29098.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19807.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24312.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 19450.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29098.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8401.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11281.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29098.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11281.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14964.22 } ] } ] }, { "description": "12015 O SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM (RH)", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 896.75, "discounted_cash": 197.0, "minimum": 119.4, "maximum": 896.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 779.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 896.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 757.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Thyroid Mets Image w Addl Study", "code_information": [ { "code": "78016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1218.75, "discounted_cash": 394.0, "minimum": 365.625, "maximum": 1218.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1218.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1218.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1218.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1218.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "845", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7524.0, "minimum": 5791.77, "maximum": 21733.7193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 12536.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15388.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 12310.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18417.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5791.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7524.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18417.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7524.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9471.22 } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "654", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22337.0, "minimum": 19532.69, "maximum": 79134.4534, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 41209.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 50582.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 40466.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 54818.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19532.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22337.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54818.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 22337.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31132.92 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42362.0, "minimum": 40691.5, "maximum": 117483.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 79971.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 98160.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 78528.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 117483.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41776.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42362.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 117483.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 42362.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60416.3 } ] } ] }, { "description": "23044 O ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB (RH)", "code_information": [ { "code": "23044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4374.25, "discounted_cash": 3228.0, "minimum": 1312.275, "maximum": 4374.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4374.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4374.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4374.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4374.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93454 FAC CORONARY ARTERY ANGIO S&I", "code_information": [ { "code": "93454", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12945.5, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 12945.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12945.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Thyroid Image w Uptake", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1016.25, "discounted_cash": 394.0, "minimum": 304.875, "maximum": 1016.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1016.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1016.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1016.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1016.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INT REP FACE 2.6-5 FAC", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 401.0, "minimum": 167.625, "maximum": 1919.5443, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "I-D PERIANAL ABSCESS FAC", "code_information": [ { "code": "46050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2032.5, "discounted_cash": 917.0, "minimum": 332.1, "maximum": 2032.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2032.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2032.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2032.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1551.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SLP Team Conference 30 Min Non Physician Unit", "code_information": [ { "code": "99368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.0, "minimum": 39.9, "maximum": 115.976, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "46999 O UNLST PROC ANUS (RH)", "code_information": [ { "code": "46999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1439.5, "discounted_cash": 917.0, "minimum": 431.85, "maximum": 1439.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1439.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1439.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1439.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1439.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Thyroxine, Free (FT4)", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.0, "discounted_cash": 9.0, "minimum": 8.7656, "maximum": 176.144, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 154.13, "10th_percentile": 154.13, "90th_percentile": 154.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 135.89, "10th_percentile": 135.89, "90th_percentile": 138.49, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 40.32, "10th_percentile": 40.32, "90th_percentile": 161.6, "count": "14" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 176.14, "10th_percentile": 176.14, "90th_percentile": 176.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 161.6, "10th_percentile": 135.74, "90th_percentile": 161.6, "count": "46" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12458.0, "minimum": 10698.99, "maximum": 64808.6009, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22086.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27110.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21688.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32445.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10698.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32445.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12458.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16685.86 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [ { "code": "673", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33002.0, "minimum": 28997.6, "maximum": 92361.6302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 61853.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75922.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 60737.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 77748.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28997.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33002.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77748.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 92361.63, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 30590.12, "10th_percentile": 30590.12, "90th_percentile": 30590.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 33002.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46728.85 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "724", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6034.0, "minimum": 4546.62, "maximum": 14180.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 9652.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11848.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 9478.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14180.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4546.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6034.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14180.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6034.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7292.49 } ] } ] }, { "description": "81025 O URINE PREGNANCY TST (RH)", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.5, "discounted_cash": 8.0, "minimum": 8.3672, "maximum": 66.926, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.58, "10th_percentile": 51.58, "90th_percentile": 61.4, "count": "27" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 51.63, "10th_percentile": 51.63, "90th_percentile": 52.62, "count": "50" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 38.49, "10th_percentile": 38.49, "90th_percentile": 61.4, "count": "16" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 45.18, "10th_percentile": 45.18, "90th_percentile": 45.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "99282 H EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY (RH)", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.25, "discounted_cash": 151.0, "minimum": 42.075, "maximum": 418.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 244.61, "10th_percentile": 244.61, "90th_percentile": 291.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 288.29, "10th_percentile": 288.29, "90th_percentile": 288.29, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 364.93, "10th_percentile": 364.93, "90th_percentile": 364.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Des-gamma-carboxy Prothrombin", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.5, "discounted_cash": 64.0, "minimum": 62.5936, "maximum": 238.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.24, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.59, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PARAGARD INTRAUTERINE COPP J7300 - AMB COPPER (RH)", "code_information": [ { "code": "J7300", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1762.5, "minimum": 528.75, "maximum": 1762.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1762.5 } ] } ] }, { "description": "Droperidol Inj 2.5 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00143951401", "type": "NDC" }, { "code": "J1790", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 15.13, "10th_percentile": 12.71, "90th_percentile": 25.89, "count": "1 through 10" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [ { "code": "564", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12787.0, "minimum": 10860.95, "maximum": 27892.605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22724.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27892.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 22314.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22805.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10860.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22805.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17167.43 } ] } ] }, { "description": "IR Liver Biopsy 47000", "code_information": [ { "code": "47000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3277.0, "discounted_cash": 1629.0, "minimum": 983.1, "maximum": 3277.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2189.56, "10th_percentile": 2189.56, "90th_percentile": 2189.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3277.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3277.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3277.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2337.72, "10th_percentile": 2337.72, "90th_percentile": 2337.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37214 FAC CESSATION THROMBLYSIS", "code_information": [ { "code": "37214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6449.0, "discounted_cash": 3115.0, "minimum": 1934.7, "maximum": 6449.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6449.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6449.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6449.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11423 O EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM (RH)", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1051.75, "discounted_cash": 1629.0, "minimum": 315.525, "maximum": 1051.75, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS WITH CC", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10906.0, "minimum": 8956.89, "maximum": 23423.9336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19083.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23423.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 18739.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15337.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8956.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15337.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14417.03 } ] } ] }, { "description": "15275 O SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM (RH)", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1226.0, "discounted_cash": 729.0, "minimum": 367.8, "maximum": 1226.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1226.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1226.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1226.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1226.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "315", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8374.0, "minimum": 6660.4, "maximum": 23231.8131, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 20913.96, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11637.51, "10th_percentile": 11637.51, "90th_percentile": 11637.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14181.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17406.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13925.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16272.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6660.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8374.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16272.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 23231.81, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 43221.85, "10th_percentile": 43221.85, "90th_percentile": 43221.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8374.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10713.51 } ] } ] }, { "description": "DISTAL RADIAL FX MAN FAC", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 756.25, "discounted_cash": 1586.0, "minimum": 226.875, "maximum": 2430.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 579.74, "10th_percentile": 579.74, "90th_percentile": 1548.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 756.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7054.0, "minimum": 5548.14, "maximum": 18710.1349, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11627.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14271.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 11417.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11840.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7054.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11840.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7054.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8783.9 } ] } ] }, { "description": "10 MCG MOMETASONE FUR SINUS IMP J7401 - AMB MOMETASONE (RH)", "code_information": [ { "code": "J7402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8448.5, "discounted_cash": 11.0, "minimum": 11.345, "maximum": 7367.092, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.29, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "23600 O CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION (RH)", "code_information": [ { "code": "23600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2445.25, "discounted_cash": 243.0, "minimum": 202.2, "maximum": 2132.258, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "29440 O ADDING WALKER PREVIOUSLY APPLIED CAST (RH)", "code_information": [ { "code": "29440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 317.75, "discounted_cash": 160.0, "minimum": 95.325, "maximum": 317.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 317.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 317.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC PIN HAND DISLOCATION ASC", "code_information": [ { "code": "26676", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "99453 O REM MNTR PHYSIOL PARAM SETUP (RH)", "code_information": [ { "code": "99453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 131.0, "minimum": 44.25, "maximum": 147.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 147.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 51.0, "minimum": 51.42, "maximum": 322.422, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 248.47, "10th_percentile": 248.47, "90th_percentile": 566.73, "count": "96" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 235.53, "10th_percentile": 235.53, "90th_percentile": 1848.75, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 253.5, "10th_percentile": 248.73, "90th_percentile": 746.19, "count": "200" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 140.85, "10th_percentile": 140.63, "90th_percentile": 422.55, "count": "56" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 231.06, "10th_percentile": 231.06, "90th_percentile": 322.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37288 REVSC EVSC TPVT ATHRC SF 1st FAC", "code_information": [ { "code": "37288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70981.75, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 70981.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70981.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70981.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Blood Patch Spinal Puncture", "code_information": [ { "code": "62272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1059.0, "discounted_cash": 696.0, "minimum": 172.65, "maximum": 1059.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1059.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1059.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1059.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1059.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC TREAT METACARPAL FRACTURE PERCUT ASC", "code_information": [ { "code": "26608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IV Infusion Hydration 1 - 8 Hr", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.0, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 282.528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 259.2, "10th_percentile": 217.73, "90th_percentile": 435.46, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 239.4, "10th_percentile": 239.4, "90th_percentile": 239.4, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 254.34, "10th_percentile": 172.96, "90th_percentile": 1397.1, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 282.53, "10th_percentile": 282.53, "90th_percentile": 282.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51055.0, "minimum": 44697.26, "maximum": 155998.2014, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 96798.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 118814.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 95051.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 154164.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44697.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 154165.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73128.38 } ] } ] }, { "description": "14021 O ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM (RH)", "code_information": [ { "code": "14021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5808.75, "discounted_cash": 2035.0, "minimum": 1742.625, "maximum": 5808.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5808.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5808.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5808.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "23931 O INCISION&DRAINAGE UPPER ARM/ELBOW BURSA (RH)", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3777.25, "discounted_cash": 1629.0, "minimum": 274.575, "maximum": 3777.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3777.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3777.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3777.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CCMCC", "code_information": [ { "code": "976", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7913.0, "minimum": 6942.09, "maximum": 19522.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 13289.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16311.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13049.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19522.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7913.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19522.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7913.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10039.54 } ] } ] }, { "description": "99454 O REM MNTR PHYSIOL PARAM DEV (RH)", "code_information": [ { "code": "99454", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 371.5, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 323.948, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567084001", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10718.0, "minimum": 8615.67, "maximum": 27499.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 18718.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22975.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 18380.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27498.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8615.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10718.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27499.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10718.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14141.22 } ] } ] }, { "description": "Cardiac Rehab Phase II w/ tele", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.25, "discounted_cash": 127.0, "minimum": 38.475, "maximum": 128.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 128.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 128.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 128.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ropivacaine HCl Inj 5 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323028605", "type": "NDC" }, { "code": "J2795", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.84, "10th_percentile": 11.99, "90th_percentile": 35.84, "count": "13" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 35.84, "10th_percentile": 35.84, "90th_percentile": 37.78, "count": "1 through 10" } ] } ] }, { "description": "88104 AP Bill Non-Gyn Cytology", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.5, "discounted_cash": 36.0, "minimum": 27.45, "maximum": 91.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Plethysmography Lung Volumes", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1180.25, "discounted_cash": 368.0, "minimum": 354.075, "maximum": 1180.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 167.2, "10th_percentile": 167.2, "90th_percentile": 167.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1180.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1180.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1180.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 160.72, "10th_percentile": 160.72, "90th_percentile": 167.48, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 167.41, "10th_percentile": 162.48, "90th_percentile": 900.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 160.22, "10th_percentile": 160.22, "90th_percentile": 168.27, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 165.53, "10th_percentile": 165.53, "90th_percentile": 165.53, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 183.92, "10th_percentile": 183.92, "90th_percentile": 1029.18, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Mech Removal Intracath OBS-CVAD", "code_information": [ { "code": "75902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1044.75, "minimum": 313.425, "maximum": 911.022, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 614.27 } ] } ] }, { "description": "XR Cholangiogram Intraoperative Addition", "code_information": [ { "code": "74301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1225.75, "minimum": 157.9777, "maximum": 1068.854, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.98 } ] } ] }, { "description": "MRI Lumbar Spine w Contrast", "code_information": [ { "code": "72149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2126.25, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1854.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1621.69, "10th_percentile": 1621.69, "90th_percentile": 1621.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1708.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OT Biofeedback Training 1st 15min units", "code_information": [ { "code": "90912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.5, "discounted_cash": 36.0, "minimum": 35.2958, "maximum": 131.236, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Neck w+wo Contrast", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2882.5, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2513.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1328.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TX TARSAL FX NO MANI FAC", "code_information": [ { "code": "28450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.25, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 1345.932, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "US Duplex Scan Penile Vessel Complete", "code_information": [ { "code": "93980", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 978.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 852.816, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Elbow Left w+wo Contrast", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2616.654, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1140.74, "10th_percentile": 1140.74, "90th_percentile": 1140.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 2288.67, "10th_percentile": 2288.67, "90th_percentile": 2288.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2609.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1140.74, "10th_percentile": 1140.74, "90th_percentile": 1140.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14464.0, "minimum": 12218.22, "maximum": 31877.0047, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 25970.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31877.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 25501.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21792.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12218.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14464.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21792.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14464.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19619.76 } ] } ] }, { "description": "11420 O EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/< (RH)", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.5, "discounted_cash": 1629.0, "minimum": 178.05, "maximum": 3522.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 593.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITH CCMCC", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14823.0, "minimum": 11215.4354, "maximum": 56114.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 26665.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32729.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 26183.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56114.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13929.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14823.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56114.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14823.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20144.7 } ] } ] }, { "description": "99282 - Level 2 - Lynx Visit Level", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.5, "discounted_cash": 151.0, "minimum": 42.075, "maximum": 418.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 244.61, "10th_percentile": 244.61, "90th_percentile": 291.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 418.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 418.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 418.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 308.91, "10th_percentile": 279.92, "90th_percentile": 559.84, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 282.97, "10th_percentile": 282.97, "90th_percentile": 319.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 406.68, "10th_percentile": 320.82, "90th_percentile": 585.49, "count": "14" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 288.29, "10th_percentile": 288.29, "90th_percentile": 288.29, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 364.93, "10th_percentile": 364.93, "90th_percentile": 364.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 256.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64611 O CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS (RH)", "code_information": [ { "code": "64611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 783.25, "discounted_cash": 302.0, "minimum": 234.975, "maximum": 783.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 783.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 783.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 783.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [ { "code": "242", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25330.0, "minimum": 23477.15, "maximum": 88478.321, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 47002.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57693.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 46154.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69115.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23477.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69115.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 25330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35509.3 } ] } ] }, { "description": "Morphine Sulfate IV Soln 1 MG/ML - 09999612701 - 25000001", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "09999612701", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 47.95, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "Pleuracentesis W/ Imaging", "code_information": [ { "code": "32557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3728.5, "discounted_cash": 1553.0, "minimum": 1118.55, "maximum": 3728.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3728.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3728.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3728.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C2625) STENT NON-COR TEMP W/DELIV SYSTEM", "code_information": [ { "code": "C2625", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 208.93, "10th_percentile": 208.93, "90th_percentile": 208.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 220.4, "10th_percentile": 220.4, "90th_percentile": 220.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 220.4, "10th_percentile": 206.02, "90th_percentile": 250.7, "count": "1 through 10" } ] } ] }, { "description": "Fetal Screen", "code_information": [ { "code": "85461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.75, "discounted_cash": 9.0, "minimum": 9.096, "maximum": 201.214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Unlisted 76499", "code_information": [ { "code": "76499", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.0, "discounted_cash": 85.0, "minimum": 45.3, "maximum": 151.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 151.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11000 O DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF (RH)", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.0, "discounted_cash": 401.0, "minimum": 41.4, "maximum": 648.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Factor XI Activity", "code_information": [ { "code": "85270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.75, "discounted_cash": 17.0, "minimum": 17.3952, "maximum": 232.606, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "12036 O REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM (RH)", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2524.75, "discounted_cash": 729.0, "minimum": 440.7, "maximum": 2524.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2524.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2524.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2524.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC KNEE ARTHROSCOPY SURGERY LIMITED ASC", "code_information": [ { "code": "29875", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1653.14, "10th_percentile": 1653.14, "90th_percentile": 1653.14, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 3533.5, "10th_percentile": 3533.5, "90th_percentile": 3533.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 3359.87, "10th_percentile": 3359.87, "90th_percentile": 3561.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "20526 O INJECTION THERAPEUTIC CARPAL TUNNEL (RH)", "code_information": [ { "code": "20526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.0, "discounted_cash": 302.0, "minimum": 89.4, "maximum": 298.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INJ ANES TRIGEM FAC", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 905.75, "discounted_cash": 302.0, "minimum": 180.15, "maximum": 905.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 905.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 905.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 905.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Thyroxine Binding Globulin", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.5, "discounted_cash": 14.0, "minimum": 14.3632, "maximum": 146.932, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRT NASAL BONE FRACTURE FAC", "code_information": [ { "code": "21315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1789.5, "discounted_cash": 1530.0, "minimum": 419.25, "maximum": 1789.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1789.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1789.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1789.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1789.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "27808 O CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ (RH)", "code_information": [ { "code": "27808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2398.25, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 2091.274, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "497", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10237.0, "minimum": 9292.58, "maximum": 24338.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17788.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21833.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 17467.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24338.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9292.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24338.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13438.33 } ] } ] }, { "description": "11920 O TATTOOING INCL MICROPIGMENTATION 6.0 CM/< (RH)", "code_information": [ { "code": "11920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 717.5, "discounted_cash": 729.0, "minimum": 215.25, "maximum": 717.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 717.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KCl 40 MEQ/L (0.3%) in Dextrose 5% & NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338067504", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" } ] } ] }, { "description": "XR Small Bowel Series", "code_information": [ { "code": "74250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1010.0, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 880.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 737.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FB MUSCLE DEEP COMP FAC", "code_information": [ { "code": "20525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1862.0, "discounted_cash": 2866.0, "minimum": 558.6, "maximum": 1862.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 173.0, "minimum": 173.07, "maximum": 1849.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1417.64, "10th_percentile": 172.29, "90th_percentile": 1612.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IRR CORP CAVER PRIA FAC", "code_information": [ { "code": "41899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 811.5, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 811.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 811.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 811.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 811.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37242 FAC VASC EMBOLIZATN OCCLUSN ARTERIAL", "code_information": [ { "code": "37242", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27743.25, "discounted_cash": 18087.0, "minimum": 8322.975, "maximum": 27743.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27743.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27743.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27743.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27743.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OT No Patient Present Train Initial 30 Min Unit", "code_information": [ { "code": "G0541", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.5, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 235.876, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11641 O EXCISION MALIGNANT LES F/E/E/N/L 0.6-1.0 CM (RH)", "code_information": [ { "code": "11641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1340.25, "discounted_cash": 698.0, "minimum": 402.075, "maximum": 1340.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1340.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1340.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1340.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "59412 O EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS (RH)", "code_information": [ { "code": "59412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 846.0, "discounted_cash": 3194.0, "minimum": 253.8, "maximum": 846.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 846.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64788 O EXC NEUROFIBROMA/NEUROLEMMOMA (RH)", "code_information": [ { "code": "64788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3010.0, "discounted_cash": 1926.0, "minimum": 903.0, "maximum": 7425.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3010.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3010.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3010.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2100.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3010.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64612 O CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL (RH)", "code_information": [ { "code": "64612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1082.25, "discounted_cash": 302.0, "minimum": 235.95, "maximum": 1082.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1082.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1082.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1082.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.75, "discounted_cash": 10.0, "minimum": 10.4371, "maximum": 110.526, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 48.01, "10th_percentile": 48.01, "90th_percentile": 48.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 80.74, "10th_percentile": 80.74, "90th_percentile": 80.74, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 85.26, "10th_percentile": 85.26, "90th_percentile": 85.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.35, "10th_percentile": 10.74, "90th_percentile": 111.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Influenza A NAT", "code_information": [ { "code": "87502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 383.25, "discounted_cash": 95.0, "minimum": 93.0984, "maximum": 383.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 289.2, "10th_percentile": 289.2, "90th_percentile": 289.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 383.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "57170 O DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS (RH)", "code_information": [ { "code": "57170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 457.75, "discounted_cash": 199.0, "minimum": 137.325, "maximum": 457.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 457.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 457.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 457.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH MCC", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15766.0, "minimum": 14232.33, "maximum": 41854.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 28490.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34970.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 27976.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41854.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14232.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15766.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41854.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 15766.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21523.79 } ] } ] }, { "description": "96361 O IV INFUSION HYDRATION EACH ADDITIONAL HOUR (RH)", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.5, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 282.528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 259.2, "10th_percentile": 217.73, "90th_percentile": 435.46, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 239.4, "10th_percentile": 239.4, "90th_percentile": 239.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 196.44, "10th_percentile": 196.44, "90th_percentile": 196.44, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 254.34, "10th_percentile": 172.96, "90th_percentile": 1397.1, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 282.53, "10th_percentile": 282.53, "90th_percentile": 282.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C2617) STENT NON-COR TEMP W/O DELIV SYSTEM", "code_information": [ { "code": "C2617", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 180.6, "10th_percentile": 180.6, "90th_percentile": 365.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 219.28, "10th_percentile": 208.93, "90th_percentile": 634.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 422.4, "10th_percentile": 220.4, "90th_percentile": 913.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 220.4, "10th_percentile": 220.4, "90th_percentile": 220.4, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12850.0, "minimum": 10409.68, "maximum": 38867.0705, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22844.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28040.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 22432.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 34102.29, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 36427.46, "10th_percentile": 36427.46, "90th_percentile": 36427.46, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36305.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10409.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12850.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36305.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12850.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17258.62 } ] } ] }, { "description": "Estrone, Serum", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.0, "discounted_cash": 24.0, "minimum": 24.2464, "maximum": 116.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 111.53, "10th_percentile": 111.53, "90th_percentile": 111.53, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.31, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.25, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fungal Culture, Skin Hair Nails", "code_information": [ { "code": "87101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 7.0, "minimum": 7.4926, "maximum": 147.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 101.44, "10th_percentile": 101.44, "90th_percentile": 101.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "62323 O NJX INTERLAMINAR LMBR/SAC W IMAGE (RH)", "code_information": [ { "code": "62323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1354.75, "discounted_cash": 696.0, "minimum": 406.425, "maximum": 2805.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1849.59, "10th_percentile": 1849.59, "90th_percentile": 1849.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1354.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1354.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1354.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "17280 O DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/< (RH)", "code_information": [ { "code": "17280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 635.25, "discounted_cash": 197.0, "minimum": 190.575, "maximum": 635.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 635.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 635.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 635.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Thoracic Spine AP+Lateral", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 486.75, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 486.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 367.4, "10th_percentile": 367.4, "90th_percentile": 367.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 291.16, "10th_percentile": 291.16, "90th_percentile": 308.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 357.02, "10th_percentile": 357.02, "90th_percentile": 371.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 92.04, "10th_percentile": 92.04, "90th_percentile": 92.04, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 424.45, "10th_percentile": 424.45, "90th_percentile": 424.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "62367 O ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL (RH)", "code_information": [ { "code": "62367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 259.0, "discounted_cash": 303.0, "minimum": 77.7, "maximum": 259.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Brain Imaging Complete", "code_information": [ { "code": "78605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 535.0, "minimum": 420.525, "maximum": 1401.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1401.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1401.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1401.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1401.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bill IRL Enzyme Ea Cell", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 168.0, "minimum": 9.0, "maximum": 30.0, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "N-STATE 90648 HEMOPHILUS INFLUENZA B VACCINE PRP-T 4 DOSE - AMB HAEM (RH)", "code_information": [ { "code": "90648", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.5, "minimum": 28.595, "maximum": 194.892, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 316.63, "10th_percentile": 316.63, "90th_percentile": 316.63, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.6 } ] } ] }, { "description": "35875 FAC 35875 THROMBECTOMY GRAFT", "code_information": [ { "code": "35875", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10536.25, "discounted_cash": 5490.0, "minimum": 3160.875, "maximum": 10536.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10536.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10536.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10536.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "99283 - Level 3", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 859.25, "discounted_cash": 269.0, "minimum": 71.175, "maximum": 859.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 502.15, "10th_percentile": 502.15, "90th_percentile": 597.8, "count": "47" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 859.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 859.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 859.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 875.18, "10th_percentile": 602.32, "90th_percentile": 1545.9, "count": "63" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 655.35, "10th_percentile": 580.91, "90th_percentile": 655.35, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 777.22, "10th_percentile": 582.52, "90th_percentile": 857.2, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 674.51, "10th_percentile": 591.82, "90th_percentile": 674.51, "count": "30" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 293.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 657.58, "10th_percentile": 657.58, "90th_percentile": 657.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 455.51, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TREAT VAGINAL BLEEDING FAC", "code_information": [ { "code": "57180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 607.25, "discounted_cash": 199.0, "minimum": 182.175, "maximum": 607.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 607.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 607.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 607.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Angiography Head w+wo Contrast", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1528.0, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1528.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 968.69, "10th_percentile": 968.69, "90th_percentile": 968.69, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1165.41, "10th_percentile": 1120.62, "90th_percentile": 1165.41, "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": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 726.24, "10th_percentile": 543.27, "90th_percentile": 726.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1332.42, "10th_percentile": 585.68, "90th_percentile": 1332.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HPV High Risk Screen by TMA", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.25, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 176.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 133.0, "10th_percentile": 111.72, "90th_percentile": 133.0, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 105.9, "10th_percentile": 105.9, "90th_percentile": 112.27, "count": "35" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 113.98, "10th_percentile": 113.98, "90th_percentile": 118.56, "count": "66" }, { "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": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 156.85, "10th_percentile": 156.85, "90th_percentile": 156.85, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 146.3, "10th_percentile": 146.3, "90th_percentile": 146.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "G0010 F ADM HEP B VACCINE (RH)", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.5, "discounted_cash": 71.0, "minimum": 6.45, "maximum": 21.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 14.45, "10th_percentile": 14.45, "90th_percentile": 14.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 16.48, "10th_percentile": 16.48, "90th_percentile": 16.48, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.03, "10th_percentile": 17.03, "90th_percentile": 17.03, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PER INJ MONOVISC J7327 - AMB HYALURONAN (RH)", "code_information": [ { "code": "J7327", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5936.5, "discounted_cash": 564.0, "minimum": 564.77, "maximum": 5176.628, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2224.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2702.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2162.33, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1426.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 564.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 615.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 564.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 564.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 955.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "64642 O CHEMODRNVTN 1 EXTREM 1-4 MUSCLE(S) (RH)", "code_information": [ { "code": "64642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 810.25, "discounted_cash": 696.0, "minimum": 243.075, "maximum": 810.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 810.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 810.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 810.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 810.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11884.0, "minimum": 10129.37, "maximum": 25926.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 20975.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25745.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 20596.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25926.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10129.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11884.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25926.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11884.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15846.17 } ] } ] }, { "description": "64617 O CHEMODENER MUSCLE LARYNX EMG (RH)", "code_information": [ { "code": "64617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1009.25, "discounted_cash": 696.0, "minimum": 302.775, "maximum": 1009.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1009.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1009.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1009.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1009.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "I-D ABSCESS COMPLEX FAC", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 401.0, "minimum": 167.625, "maximum": 1013.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 426.16, "10th_percentile": 426.16, "90th_percentile": 426.16, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "28124 O EXC BONE TOE PARTIAL (RH)", "code_information": [ { "code": "28124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3189.25, "discounted_cash": 3228.0, "minimum": 956.775, "maximum": 11758.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3189.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REM IMPACTED CERUMEN FAC", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.5, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 278.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 274.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 203.29, "10th_percentile": 203.29, "90th_percentile": 203.29, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "76700 O US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION (RH)", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 831.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 975.332, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 844.2, "10th_percentile": 844.2, "90th_percentile": 844.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 690.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 305.48, "10th_percentile": 305.48, "90th_percentile": 844.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Galectin-3, Serum", "code_information": [ { "code": "82777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.5, "discounted_cash": 44.0, "minimum": 43.0022, "maximum": 256.804, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16112.0, "minimum": 13533.97, "maximum": 54602.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 29160.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35792.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 28634.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 54602.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13533.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16112.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54602.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16112.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22029.82 } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33487.0, "minimum": 9595.6, "maximum": 77073.2886, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 62791.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 77073.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 61658.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9595.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29271.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33487.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9595.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 33487.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47437.3 } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "370", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6377.0, "minimum": 4831.09, "maximum": 13704.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 10316.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12663.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10130.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13704.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4831.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6377.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13704.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6377.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7794.07 } ] } ] }, { "description": "36468 O 1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRUNK (RH)", "code_information": [ { "code": "36468", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1144.75, "discounted_cash": 401.0, "minimum": 143.625, "maximum": 1144.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1144.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1144.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1144.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med Hepatitis B Surface Antigen - ECi", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 10.0, "minimum": 10.0387, "maximum": 95.266, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.4, "10th_percentile": 46.18, "90th_percentile": 82.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 65.61, "10th_percentile": 65.61, "90th_percentile": 65.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.49, "10th_percentile": 70.62, "90th_percentile": 73.49, "count": "37" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 46.18, "10th_percentile": 46.18, "90th_percentile": 46.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 90.64, "10th_percentile": 90.64, "90th_percentile": 90.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93656 FAC EP EVAL PULM VEIN ISOLTN", "code_information": [ { "code": "93656", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48093.5, "discounted_cash": 25790.0, "minimum": 14428.05, "maximum": 48093.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 31563.5, "10th_percentile": 31563.5, "90th_percentile": 31563.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 48093.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48093.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48093.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 36453.65, "10th_percentile": 36453.65, "90th_percentile": 37760.32, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28111.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 37825.77, "10th_percentile": 37825.77, "90th_percentile": 37825.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43616.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "65220 O RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP (RH)", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 609.5, "discounted_cash": 440.0, "minimum": 110.1, "maximum": 609.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 609.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 609.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 609.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 609.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [ { "code": "917", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12976.0, "minimum": 11348.9, "maximum": 32337.066, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 29110.78, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 29187.42, "10th_percentile": 29187.42, "90th_percentile": 29187.42, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 23089.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28340.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 22672.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25597.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11348.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25597.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17443.24 } ] } ] }, { "description": "Occ Med CONTRACT RATE URINE DIP POC TEST w INTERP", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 2.0, "minimum": 2.1865, "maximum": 44.036, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 40.4, "10th_percentile": 33.94, "90th_percentile": 51.8, "count": "38" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 10.06, "10th_percentile": 10.06, "90th_percentile": 51.8, "count": "13" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.46, "10th_percentile": 40.33, "90th_percentile": 56.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "57295 O REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP (RH)", "code_information": [ { "code": "57295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3853.5, "discounted_cash": 3194.0, "minimum": 1156.05, "maximum": 3853.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3853.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3853.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3853.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3481.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3853.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "738", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12216.0, "minimum": 10498.97, "maximum": 34322.8583, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 21618.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26535.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21228.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31672.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10498.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12216.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31672.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12216.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16332.19 } ] } ] }, { "description": "Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.5, "discounted_cash": 13.0, "minimum": 13.2456, "maximum": 146.932, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 134.8, "10th_percentile": 113.23, "90th_percentile": 134.8, "count": "71" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 146.93, "10th_percentile": 146.93, "90th_percentile": 146.93, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 113.35, "10th_percentile": 113.35, "90th_percentile": 115.52, "count": "119" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 60.93, "10th_percentile": 60.93, "90th_percentile": 134.8, "count": "23" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 148.28, "10th_percentile": 148.28, "90th_percentile": 148.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC SHOULDER ARTHROSCOPY SURGERY W WO MANIP ASC", "code_information": [ { "code": "29825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rheumatoid Factor", "code_information": [ { "code": "86431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.75, "discounted_cash": 5.0, "minimum": 5.5101, "maximum": 115.758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 84.17, "10th_percentile": 84.17, "90th_percentile": 100.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 84.56, "10th_percentile": 79.78, "90th_percentile": 2532.97, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 85.87, "10th_percentile": 85.87, "90th_percentile": 89.3, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 110.22, "10th_percentile": 5.67, "90th_percentile": 115.76, "count": "38" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Cholangiogram w Fluoro in the OR", "code_information": [ { "code": "74300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.0, "minimum": 210.6133, "maximum": 884.208, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 777.33, "10th_percentile": 777.33, "90th_percentile": 777.33, "count": "1 through 10" } ] } ] }, { "description": "Rubella Antibody, IgG", "code_information": [ { "code": "86762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "discounted_cash": 14.0, "minimum": 13.9842, "maximum": 87.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.32, "10th_percentile": 64.32, "90th_percentile": 68.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 58.13, "10th_percentile": 54.78, "90th_percentile": 58.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 58.96, "10th_percentile": 58.96, "90th_percentile": 61.38, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 64.32, "10th_percentile": 64.32, "90th_percentile": 64.32, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 75.68, "10th_percentile": 75.26, "90th_percentile": 79.57, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PATIENT SUPPLIED MED - AMB HYDROXYPROGESTERONE (RH)", "code_information": [ { "code": "J1729", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 0.01, "minimum": 1.0, "maximum": 29.9065, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.91 } ] } ] }, { "description": "pH, Body Fluid", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.75, "discounted_cash": 3.0, "minimum": 3.479, "maximum": 54.718, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC FUSE HAND BONES WITH GRAFT ASC", "code_information": [ { "code": "25825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13056.0, "discounted_cash": 7159.0, "minimum": 3916.8, "maximum": 13056.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13056.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13056.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13056.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Thoracic Spine wo Contrast", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1640.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1430.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 757.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [ { "code": "687", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9016.0, "minimum": 7286.08, "maximum": 21049.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15425.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18933.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 15146.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 17059.86, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13534.42, "10th_percentile": 13534.42, "90th_percentile": 13534.42, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21049.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7286.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9016.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21049.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9016.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11653.3 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9652.0, "minimum": 7342.15, "maximum": 26117.1674, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 16654.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20442.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 16353.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17363.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7342.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17363.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12581.96 } ] } ] }, { "description": "$ Platelets, pheresis, irr, ea unit", "code_information": [ { "code": "P9036", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3685.25, "discounted_cash": 944.0, "minimum": 944.48, "maximum": 3685.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3685.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3685.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3616.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1029.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1597.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cardiolipin Ab, IgG", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.0, "discounted_cash": 25.0, "minimum": 24.7323, "maximum": 294.736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 227.52, "10th_percentile": 227.52, "90th_percentile": 227.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 609.13, "10th_percentile": 609.13, "90th_percentile": 609.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 454.75, "10th_percentile": 437.07, "90th_percentile": 655.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 561.0, "10th_percentile": 561.0, "90th_percentile": 589.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Inflamation Local Whole Body 78802", "code_information": [ { "code": "78802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5434.75, "discounted_cash": 535.0, "minimum": 535.74, "maximum": 4739.102, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2110.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2563.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2051.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2149.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "46200 O FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED (RH)", "code_information": [ { "code": "46200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2919.25, "discounted_cash": 2738.0, "minimum": 875.775, "maximum": 2919.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2919.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2919.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2919.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2919.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2738.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2919.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR OF BICEPS TENDON ASC", "code_information": [ { "code": "24340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10070.5, "discounted_cash": 7159.0, "minimum": 3021.15, "maximum": 10070.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "12035 O REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM (RH)", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2253.75, "discounted_cash": 401.0, "minimum": 167.625, "maximum": 1965.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1919.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IgG Subclass 1", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 8.0, "minimum": 7.7938, "maximum": 57.552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.4, "10th_percentile": 143.4, "90th_percentile": 143.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 181.0, "10th_percentile": 181.0, "90th_percentile": 296.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL LAVAGE FAC", "code_information": [ { "code": "49084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2053.75, "discounted_cash": 894.0, "minimum": 616.125, "maximum": 2053.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2053.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2053.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2053.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "90384 RHOPHYLAC - AMB RHO IMMUNE GLOBULIN (RH)", "code_information": [ { "code": "90384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 529.5, "minimum": 123.075, "maximum": 461.724, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 306.5, "10th_percentile": 306.5, "90th_percentile": 306.5, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.65 } ] } ] }, { "description": "AMPUTATION OF TOE FAC", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8435.0, "discounted_cash": 3228.0, "minimum": 858.75, "maximum": 8435.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8435.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8435.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8435.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "356", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34456.0, "minimum": 29524.32, "maximum": 80541.3116, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 64668.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 79377.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 63501.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 64751.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29524.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34456.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64751.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 34456.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48855.32 } ] } ] }, { "description": "ADAMTS13 Activity", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 606.25, "discounted_cash": 30.0, "minimum": 29.9897, "maximum": 528.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.49, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.99, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bill Celiac Plus HLA-DQA1", "code_information": [ { "code": "81382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860.75, "discounted_cash": 123.0, "minimum": 120.1922, "maximum": 750.574, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 120.19, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 648.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 209.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "15783 O DERMABRASION SUPERFICIAL ANY SITE (RH)", "code_information": [ { "code": "15783", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3005.5, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 2620.796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1919.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14533.0, "minimum": 12098.48, "maximum": 41500.1813, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 26102.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32039.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 25631.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26943.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12098.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14533.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26943.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14533.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19719.85 } ] } ] }, { "description": "XR Abdomen 2 Views 74019", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 536.498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 464.4, "10th_percentile": 464.4, "90th_percentile": 464.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 451.28, "10th_percentile": 451.28, "90th_percentile": 469.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 173.0, "minimum": 173.07, "maximum": 1606.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "D-Dimer", "code_information": [ { "code": "85380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.75, "discounted_cash": 10.0, "minimum": 9.8929, "maximum": 130.582, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 94.92, "10th_percentile": 94.92, "90th_percentile": 94.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 95.39, "10th_percentile": 95.39, "90th_percentile": 95.39, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 100.74, "10th_percentile": 96.84, "90th_percentile": 100.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 45.5, "10th_percentile": 45.5, "90th_percentile": 45.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 53.42, "10th_percentile": 10.18, "90th_percentile": 130.58, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIV 1,2 Ab MCR", "code_information": [ { "code": "G0432", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "discounted_cash": 19.0, "minimum": 15.0, "maximum": 91.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 19.57, "10th_percentile": 19.57, "90th_percentile": 19.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [ { "code": "557", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12356.0, "minimum": 10725.99, "maximum": 34315.7346, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 21889.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26868.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21494.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21307.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10725.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21307.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16536.83 } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11974.0, "minimum": 10079.53, "maximum": 43536.5603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 39192.89, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 25600.1, "10th_percentile": 25600.1, "90th_percentile": 25600.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 21150.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25960.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 20768.73 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 38199.34, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 33422.67, "10th_percentile": 33422.67, "90th_percentile": 33422.67, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21548.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10079.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21548.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11974.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15978.52 } ] } ] }, { "description": "Atropine Sulfate Inj 0.4 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00641625101", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 19.41, "10th_percentile": 19.41, "90th_percentile": 19.41, "count": "1 through 10" } ] } ] }, { "description": "CT Guided Tissue Ablation", "code_information": [ { "code": "77013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.0, "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 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15426.0, "minimum": 13133.92, "maximum": 39783.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 27831.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34161.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 27328.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39783.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13133.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39783.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21025.54 } ] } ] }, { "description": "46611 O ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ (RH)", "code_information": [ { "code": "46611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 996.0, "discounted_cash": 917.0, "minimum": 298.8, "maximum": 996.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR HALLUX RIGIDUS ASC", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PCA3 (Prostate Cancer Biomarker)", "code_information": [ { "code": "81313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1278.25, "discounted_cash": 255.0, "minimum": 247.8576, "maximum": 1278.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1278.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [ { "code": "871", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15821.0, "minimum": 13580.34, "maximum": 46859.9621, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 42184.71, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 35783.91, "10th_percentile": 20522.27, "90th_percentile": 36744.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 28596.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35100.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 28080.51 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 39873.96, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22041.89, "10th_percentile": 22041.89, "90th_percentile": 22041.89, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29846.72 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 46752.49, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 35100.66, "10th_percentile": 35100.66, "90th_percentile": 35100.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13580.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29846.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 46859.96, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14770.48, "10th_percentile": 14739.98, "90th_percentile": 28299.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 15821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21603.86 } ] } ] }, { "description": "PATIENT SUPPLIED MED - AMB FLUPHENAZINE (RH)", "code_information": [ { "code": "J2680", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 0.01, "minimum": 1.0, "maximum": 18.9845, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.98 } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [ { "code": "064", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16342.0, "minimum": 13767.91, "maximum": 45494.806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 29604.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36338.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 29070.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45061.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13767.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16342.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45061.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16342.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22365.7 } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7190.0, "minimum": 5612.51, "maximum": 19322.4457, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14593.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 11674.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14569.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5612.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7190.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14569.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7190.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8981.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11889.1 } ] } ] }, { "description": "PNEUMOTHORAX WITH CC", "code_information": [ { "code": "200", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9408.0, "minimum": 7665.37, "maximum": 21408.5371, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 16183.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19864.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 15891.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13461.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7665.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13461.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12226.06 } ] } ] }, { "description": "NASAL HEMORR POST 2 FAC", "code_information": [ { "code": "30906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 361.75, "discounted_cash": 233.0, "minimum": 108.525, "maximum": 1592.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 361.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 361.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 361.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 361.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "92961 FAC CARDIOVERISON IN CATH LAB", "code_information": [ { "code": "92961", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1437.0, "discounted_cash": 652.0, "minimum": 431.1, "maximum": 1437.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1437.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1437.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1437.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1102.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITH CCMCC", "code_information": [ { "code": "600", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8969.0, "minimum": 6620.94, "maximum": 18821.5453, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15333.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18821.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 15057.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8790.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6620.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8790.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8969.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11584.34 } ] } ] }, { "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": 166.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 112.06, "10th_percentile": 112.06, "90th_percentile": 133.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 166.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 166.75, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 106.22, "10th_percentile": 106.22, "90th_percentile": 106.22, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 112.17, "10th_percentile": 112.17, "90th_percentile": 114.32, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 43.67, "10th_percentile": 43.67, "90th_percentile": 43.67, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 145.41, "10th_percentile": 51.27, "90th_percentile": 146.74, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Candida albicans Ab.IgG", "code_information": [ { "code": "86628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.0, "discounted_cash": 12.0, "minimum": 10.5, "maximum": 35.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "52000 O CYSTOURETHROSCOPY (RH)", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 854.25, "discounted_cash": 688.0, "minimum": 256.275, "maximum": 1069.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 854.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 854.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 854.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 646.0, "10th_percentile": 646.0, "90th_percentile": 646.0, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 854.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "26750 O CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA (RH)", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1460.25, "discounted_cash": 243.0, "minimum": 105.225, "maximum": 1273.338, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "96402 O CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO (RH)", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.5, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 365.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 267.96, "10th_percentile": 267.96, "90th_percentile": 315.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 398.75, "10th_percentile": 398.75, "90th_percentile": 398.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 321.01, "10th_percentile": 305.68, "90th_percentile": 321.01, "count": "15" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 350.9, "10th_percentile": 68.88, "90th_percentile": 365.15, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6405.84, "10th_percentile": 660.07, "90th_percentile": 6405.84, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1412.1, "10th_percentile": 1412.1, "90th_percentile": 1412.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 876.42, "10th_percentile": 752.99, "90th_percentile": 876.42, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2538.76, "10th_percentile": 665.92, "90th_percentile": 5397.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 996.91, "10th_percentile": 309.32, "90th_percentile": 5997.2, "count": "1 through 10" } ] } ] }, { "description": "XR Arthrogram Knee", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 526.25, "discounted_cash": 344.0, "minimum": 157.875, "maximum": 526.25, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 526.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 526.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 526.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 526.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MRI Femur Left w+wo Contrast", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2625.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2289.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 193.0, "10th_percentile": 193.0, "90th_percentile": 1571.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 2040.68, "10th_percentile": 2040.68, "90th_percentile": 2040.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2161.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 345.64, "10th_percentile": 345.64, "90th_percentile": 345.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 1785.42, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1450.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1480.69, "10th_percentile": 1480.69, "90th_percentile": 1480.69, "count": "1 through 10" } ] } ] }, { "description": "31297 O ENDO DILATION SPHENOID SINUS (RH)", "code_information": [ { "code": "31297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10673.75, "discounted_cash": 6963.0, "minimum": 3202.125, "maximum": 10673.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10673.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10673.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10673.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7590.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6963.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10673.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36470 O NJX SCLEROSING SOLUTION SINGLE VEIN (RH)", "code_information": [ { "code": "36470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 627.25, "discounted_cash": 401.0, "minimum": 108.15, "maximum": 627.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 627.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 627.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Reticulocyte, %", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.75, "discounted_cash": 3.0, "minimum": 3.8775, "maximum": 89.598, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 65.45, "10th_percentile": 65.45, "90th_percentile": 65.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.84, "10th_percentile": 17.84, "90th_percentile": 17.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 20.94, "10th_percentile": 3.99, "90th_percentile": 89.6, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "69436 O TYMPANOSTOMY GENERAL ANESTHESIA (RH)", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1249.75, "discounted_cash": 1530.0, "minimum": 374.925, "maximum": 1249.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1249.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INS PICC WO PORT <5YRS FAC", "code_information": [ { "code": "36568", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4125.5, "discounted_cash": 1553.0, "minimum": 1237.65, "maximum": 4125.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4125.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4125.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4125.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR OF RUPTURED TENDON ASC", "code_information": [ { "code": "24342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10070.5, "discounted_cash": 7159.0, "minimum": 3021.15, "maximum": 10070.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 7385.69, "10th_percentile": 7385.69, "90th_percentile": 7385.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 3533.5, "10th_percentile": 3533.5, "90th_percentile": 3533.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10070.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "80061 O LIPID PANEL (RH)", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.0, "discounted_cash": 13.0, "minimum": 12.0, "maximum": 172.656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.4, "10th_percentile": 125.5, "90th_percentile": 149.4, "count": "257" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 121.03, "10th_percentile": 34.09, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 127.81, "10th_percentile": 122.89, "90th_percentile": 133.19, "count": "404" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.85, "10th_percentile": 59.85, "90th_percentile": 143.4, "count": "126" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 157.74, "10th_percentile": 70.26, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Schistosoma IgG Antibody", "code_information": [ { "code": "86682", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.0, "discounted_cash": 13.0, "minimum": 12.6431, "maximum": 106.384, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 78.84, "10th_percentile": 78.84, "90th_percentile": 78.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "15200 O FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/< (RH)", "code_information": [ { "code": "15200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5933.25, "discounted_cash": 2035.0, "minimum": 1779.975, "maximum": 5933.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5933.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5933.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR SMB Via Enteroclysis", "code_information": [ { "code": "74251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1105.0, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1105.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1105.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Neostigmine Methylsulfate Inj 1 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00641614901", "type": "NDC" }, { "code": "J2710", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 146.93, "10th_percentile": 142.82, "90th_percentile": 289.75, "count": "1 through 10" } ] } ] }, { "description": "Homovanillic Acid, 24 hr Urine", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 459.5, "discounted_cash": 22.0, "minimum": 21.778, "maximum": 400.684, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Biliary Access Assist Endo 47541", "code_information": [ { "code": "47541", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10611.25, "discounted_cash": 6387.0, "minimum": 3183.375, "maximum": 10611.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10611.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10611.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10611.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6962.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10611.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RMV DEVL TIS 20 CM /< FAC", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.75, "discounted_cash": 197.0, "minimum": 57.825, "maximum": 192.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 192.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 14767.0, "minimum": 13655.78, "maximum": 109576.331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 26556.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32596.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 26076.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43904.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13655.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14767.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43904.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14767.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20062.4 } ] } ] }, { "description": "99281 - Level 1 - Lynx Visit Level", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.75, "discounted_cash": 83.0, "minimum": 75.525, "maximum": 251.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 175.2, "10th_percentile": 175.2, "90th_percentile": 175.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 251.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 251.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 362.62, "10th_percentile": 362.62, "90th_percentile": 362.62, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 170.25, "10th_percentile": 170.25, "90th_percentile": 192.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 167.89, "10th_percentile": 167.89, "90th_percentile": 192.99, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 197.62, "10th_percentile": 173.45, "90th_percentile": 197.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 192.72, "10th_percentile": 192.72, "90th_percentile": 219.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "57522 O CONIZATION CERVIX W/WO D&C RPR ELTRD EXC (RH)", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2186.0, "discounted_cash": 3194.0, "minimum": 655.8, "maximum": 2186.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3077.28, "10th_percentile": 3077.28, "90th_percentile": 3077.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2186.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36223 FAC ANGIO COM CARTD W/IPS INT", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7345.5, "discounted_cash": 5490.0, "minimum": 2203.65, "maximum": 7345.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7345.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7345.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7345.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7345.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BIVALVE BOOT BODY CAST FAC", "code_information": [ { "code": "29700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.25, "discounted_cash": 275.0, "minimum": 53.175, "maximum": 304.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "10180 O INCISION & DRAINAGE COMPLEX PO WOUND INFECTION (RH)", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1098.5, "discounted_cash": 2866.0, "minimum": 329.55, "maximum": 6888.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1098.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "13100 O REPAIR COMPLEX TRUNK 1.1-2.5 CM (RH)", "code_information": [ { "code": "13100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1962.5, "discounted_cash": 729.0, "minimum": 588.75, "maximum": 1962.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1962.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1962.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1962.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16632.0, "minimum": 13524.28, "maximum": 39022.8574, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 30165.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37026.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 29621.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27820.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13524.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27820.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22789.43 } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "117", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9299.0, "minimum": 7005.77, "maximum": 23462.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15971.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19603.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 15683.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23461.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7005.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9299.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23462.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9299.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12065.91 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [ { "code": "500", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25117.0, "minimum": 21931.62, "maximum": 70451.1668, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 46590.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57187.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 45749.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 66072.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21931.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25117.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66072.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 25117.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35197.89 } ] } ] }, { "description": "Contrast Baths/15M PT", "code_information": [ { "code": "97034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.75, "discounted_cash": 13.0, "minimum": 12.993, "maximum": 95.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Knee Left 4 Views", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504.75, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 320.04, "10th_percentile": 320.04, "90th_percentile": 381.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 480.02, "10th_percentile": 480.02, "90th_percentile": 480.02, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 384.97, "10th_percentile": 384.97, "90th_percentile": 384.97, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 440.14, "10th_percentile": 41.17, "90th_percentile": 1025.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Smooth Muscle Ab, IgG Titer", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.75, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 188.134, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 162.8, "10th_percentile": 162.8, "90th_percentile": 162.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.05, "10th_percentile": 12.05, "90th_percentile": 188.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med Arsenic Fractionated, Urine", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.0, "discounted_cash": 18.0, "minimum": 7.5, "maximum": 41.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 41.75, "10th_percentile": 41.75, "90th_percentile": 41.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 28.62, "10th_percentile": 28.62, "90th_percentile": 28.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 36.74, "10th_percentile": 36.74, "90th_percentile": 37.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC CAPSULOTMY METATRSLPHLGNL; EA JT ASC", "code_information": [ { "code": "28270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CK (Creatine Kinase)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.5, "discounted_cash": 6.0, "minimum": 6.3264, "maximum": 117.284, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 107.6, "10th_percentile": 90.38, "90th_percentile": 107.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.91, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 85.68, "10th_percentile": 85.68, "90th_percentile": 85.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 92.21, "10th_percentile": 90.48, "90th_percentile": 92.21, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 29.1, "10th_percentile": 29.1, "90th_percentile": 29.1, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 117.28, "10th_percentile": 117.28, "90th_percentile": 117.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Indirect Calorimetry Measurement PFT", "code_information": [ { "code": "94690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.0, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 575.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Alpha-1-Antitrypsin Level", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.5, "discounted_cash": 13.0, "minimum": 13.061, "maximum": 141.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 60.08, "10th_percentile": 60.08, "90th_percentile": 60.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 103.51, "10th_percentile": 103.51, "90th_percentile": 103.51, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 109.31, "10th_percentile": 109.31, "90th_percentile": 109.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 70.52, "10th_percentile": 13.44, "90th_percentile": 143.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med Alcohol, Isopropyl", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "minimum": 30.0, "maximum": 812.704, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.82 } ] } ] }, { "description": "96374 - ED IV Push INITL or Single", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.5, "discounted_cash": 209.0, "minimum": 95.925, "maximum": 506.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 340.37, "10th_percentile": 340.37, "90th_percentile": 405.2, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 506.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 506.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 506.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 374.24, "10th_percentile": 374.24, "90th_percentile": 441.67, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 386.31, "10th_percentile": 386.31, "90th_percentile": 393.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 441.66, "10th_percentile": 441.66, "90th_percentile": 441.66, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 397.6, "10th_percentile": 313.8, "90th_percentile": 401.15, "count": "16" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 441.67, "10th_percentile": 441.67, "90th_percentile": 445.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "$ PTT Heparin Neutralized", "code_information": [ { "code": "85525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.25, "discounted_cash": 11.0, "minimum": 11.5061, "maximum": 133.634, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "92930 PRQ TCAT PLMT NTRAC ST 2 PLUS LES FAC", "code_information": [ { "code": "92930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70981.75, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 70981.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70981.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70981.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16016.0, "minimum": 13559.58, "maximum": 50357.4686, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 28974.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35565.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 28452.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 42738.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13559.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16016.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42738.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 50357.47, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15796.33, "10th_percentile": 15796.33, "90th_percentile": 35190.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 16016.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21889.69 } ] } ] }, { "description": "15822 O BLEPHAROPLASTY UPPER EYELID (RH)", "code_information": [ { "code": "15822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3288.25, "discounted_cash": 2035.0, "minimum": 986.475, "maximum": 3288.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3288.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3288.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3288.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3288.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Covid-19 Antigen POC (RH)", "code_information": [ { "code": "87811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.25, "discounted_cash": 41.0, "minimum": 14.175, "maximum": 50.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 41.38, "10th_percentile": 41.38, "90th_percentile": 41.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Community Work Training/15 min OT", "code_information": [ { "code": "97537", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.75, "discounted_cash": 30.0, "minimum": 27.225, "maximum": 90.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.81, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC FUSION OF FOOT BONES SUBTALAR ASC", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26727.0, "discounted_cash": 12667.0, "minimum": 8018.1, "maximum": 26727.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26727.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26727.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26727.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13808.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21424.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "31575 O LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC (RH)", "code_information": [ { "code": "31575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603.25, "discounted_cash": 196.0, "minimum": 147.675, "maximum": 603.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 603.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 603.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 603.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 187.9, "10th_percentile": 187.9, "90th_percentile": 187.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "20950 O MNTR INTRSTL FLD (RH)", "code_information": [ { "code": "20950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1368.0, "discounted_cash": 698.0, "minimum": 410.4, "maximum": 2221.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1368.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1368.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1368.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "69540 O EXCISION AURAL POLYP (RH)", "code_information": [ { "code": "69540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1257.25, "discounted_cash": 1530.0, "minimum": 377.175, "maximum": 1257.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1257.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "24071 O EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/> (RH)", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3439.75, "discounted_cash": 2866.0, "minimum": 1031.925, "maximum": 3439.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3439.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3439.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3439.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3439.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REPAIR OF FOOT TENDON FAC", "code_information": [ { "code": "28208", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5055.5, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 5055.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5055.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5055.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5055.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5055.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cystic Fibrosis (CFTR) 165 Pathogenic Variants.", "code_information": [ { "code": "81220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 680.5, "discounted_cash": 556.0, "minimum": 204.15, "maximum": 680.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 676.1, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 540.9, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 680.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 606.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 680.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93261 FAC INTERGTN SUBQ LEAD DEFIB SYS", "code_information": [ { "code": "93261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.25, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 146.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RPR Quantitative Titer", "code_information": [ { "code": "86593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.75, "discounted_cash": 4.0, "minimum": 4.2759, "maximum": 57.334, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 4.4, "10th_percentile": 4.4, "90th_percentile": 57.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 83749.0, "minimum": 14608.7, "maximum": 196493.2471, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 160083.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 196493.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 157194.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14608.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75400.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 83749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14608.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 83749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 120938.26 } ] } ] }, { "description": "US Bone Density Measurement", "code_information": [ { "code": "76977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.5, "discounted_cash": 103.0, "minimum": 40.9467, "maximum": 242.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REMOVAL OF TENDON LESION ASC", "code_information": [ { "code": "27630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 3359.87, "10th_percentile": 3359.87, "90th_percentile": 3359.87, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR ERCP Biliary", "code_information": [ { "code": "74328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1545.75, "minimum": 463.725, "maximum": 1347.894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 979.94, "10th_percentile": 979.94, "90th_percentile": 979.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1178.94, "10th_percentile": 1178.94, "90th_percentile": 1178.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1347.89, "10th_percentile": 1347.89, "90th_percentile": 1347.89, "count": "1 through 10" } ] } ] }, { "description": "ST Fat Qnt", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.5, "discounted_cash": 16.0, "minimum": 16.3262, "maximum": 168.732, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32759.0, "minimum": 11182.2056, "maximum": 90175.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 14961.7, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 1571.33, "10th_percentile": 1571.33, "90th_percentile": 3089.87, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 61382.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75344.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 60275.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 90175.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28865.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32759.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 90175.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 16619.88, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4746.44, "10th_percentile": 4746.44, "90th_percentile": 4746.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 32759.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46372.96 } ] } ] }, { "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": 25543.0, "minimum": 22012.6, "maximum": 58199.3407, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 47415.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58199.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 46559.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44358.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22012.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25543.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44358.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 25543.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35820.71 } ] } ] }, { "description": "REHABILITATION WITHOUT CCMCC", "code_information": [ { "code": "946", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9769.0, "minimum": 7727.66, "maximum": 24800.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 16882.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20722.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 16577.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24800.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7727.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9769.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24800.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 9769.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12754.34 } ] } ] }, { "description": "Erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.0, "discounted_cash": 18.0, "minimum": 18.2601, "maximum": 260.728, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 83.99, "10th_percentile": 83.99, "90th_percentile": 83.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 201.14, "10th_percentile": 201.14, "90th_percentile": 201.14, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 18.79, "10th_percentile": 18.79, "90th_percentile": 98.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [ { "code": "769", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13899.0, "minimum": 9525.83, "maximum": 30534.4156, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 24876.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30534.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 24427.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26441.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9525.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13899.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26441.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13899.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18793.41 } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "468", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21947.0, "minimum": 18156.72, "maximum": 54734.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 40454.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 49655.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 39724.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 54734.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18156.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21947.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54734.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 21947.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30562.38 } ] } ] }, { "description": "PM DEVICE PROGR EVAL DU FAC", "code_information": [ { "code": "93280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.5, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 208.844, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "51700 O BLDR IRRIGATION SMPL LAVAGE &/INSTLJ (RH)", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.75, "discounted_cash": 246.0, "minimum": 69.525, "maximum": 893.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 235.39, "10th_percentile": 235.39, "90th_percentile": 235.39, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Inject Gastrostomy Tube 49465", "code_information": [ { "code": "49465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.75, "discounted_cash": 235.0, "minimum": 194.025, "maximum": 646.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 646.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 646.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 646.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 563.97, "10th_percentile": 563.97, "90th_percentile": 563.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Vitamin C Level", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.25, "discounted_cash": 9.0, "minimum": 9.6111, "maximum": 120.554, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 110.6, "10th_percentile": 110.6, "90th_percentile": 110.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Lumbar Punc Diag 62328", "code_information": [ { "code": "62328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2805.25, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 2805.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2805.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37609 O LIGATION/BIOPSY TEMPORAL ARTERY (RH)", "code_information": [ { "code": "37609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1742.25, "discounted_cash": 1629.0, "minimum": 522.675, "maximum": 4866.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 7670.71, "10th_percentile": 7670.71, "90th_percentile": 7670.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1742.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1742.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1742.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1742.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1742.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "12055 O REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM (RH)", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2804.25, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 2445.306, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1919.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lyme IgG, Western Blot", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.5, "discounted_cash": 15.0, "minimum": 15.0532, "maximum": 97.228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 138.48, "10th_percentile": 138.48, "90th_percentile": 138.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 150.01, "10th_percentile": 144.32, "90th_percentile": 150.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 138.48, "10th_percentile": 138.48, "90th_percentile": 138.48, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 162.56, "10th_percentile": 30.98, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "100 MG THIAMINE HCL J3411 - AMB THIAMINE (RH)", "code_information": [ { "code": "J3411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "minimum": 3.784, "maximum": 79.57, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.78 } ] } ] }, { "description": "EXC LESION <.5CM SCALP FAC", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3522.75, "discounted_cash": 1629.0, "minimum": 178.05, "maximum": 3522.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3522.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3522.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3522.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylenetetrahydrofolate Mutation", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.75, "discounted_cash": 65.0, "minimum": 63.4974, "maximum": 358.174, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.37, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 225.82, "10th_percentile": 225.82, "90th_percentile": 225.82, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 110.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "24576 O CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ (RH)", "code_information": [ { "code": "24576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2434.0, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 2122.448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93289 FAC LCD DEVICE INTERROGATE", "code_information": [ { "code": "93289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.75, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 195.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SHAVE LESION <.5 TRUNK FAC", "code_information": [ { "code": "11300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.0, "discounted_cash": 401.0, "minimum": 50.4, "maximum": 353.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "26910 O AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER (RH)", "code_information": [ { "code": "26910", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5652.0, "discounted_cash": 3228.0, "minimum": 1695.6, "maximum": 5652.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5652.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5652.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5652.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "59160 O CURETTAGE POSTPARTUM (RH)", "code_information": [ { "code": "59160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1529.0, "discounted_cash": 3194.0, "minimum": 458.7, "maximum": 1529.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1529.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "XR Humerus Left", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.75, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 262.25, "10th_percentile": 262.25, "90th_percentile": 262.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 315.57, "10th_percentile": 315.57, "90th_percentile": 315.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 360.79, "10th_percentile": 343.42, "90th_percentile": 686.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EX BN LS TR 06-1 CM FAC", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1413.25, "discounted_cash": 401.0, "minimum": 95.325, "maximum": 1413.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1413.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1413.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1413.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "85097 AP Bill Bone Marrow Aspiration", "code_information": [ { "code": "85097", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.5, "discounted_cash": 794.0, "minimum": 77.55, "maximum": 258.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 195.12, "10th_percentile": 195.12, "90th_percentile": 195.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 258.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "92625 O ASSESSMENT OF TINNITUS (RH)", "code_information": [ { "code": "92625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 484.5, "discounted_cash": 126.0, "minimum": 126.95, "maximum": 484.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 484.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 484.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "23650 O CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES (RH)", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2280.5, "discounted_cash": 243.0, "minimum": 100.725, "maximum": 1988.596, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 214.87, "10th_percentile": 214.87, "90th_percentile": 214.87, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 256.18, "10th_percentile": 256.18, "90th_percentile": 256.18, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "69220 O DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE (RH)", "code_information": [ { "code": "69220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 793.75, "discounted_cash": 197.0, "minimum": 197.97, "maximum": 793.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 779.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 793.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 757.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Exch Biliary Drg Cath 47536", "code_information": [ { "code": "47536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12509.5, "discounted_cash": 3532.0, "minimum": 3532.78, "maximum": 12509.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12509.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12509.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12509.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REMOVE WRIST TENDON LESION ASC", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2430.75, "discounted_cash": 1586.0, "minimum": 600.375, "maximum": 2430.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1920.29, "10th_percentile": 1920.29, "90th_percentile": 1920.29, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 2146.51, "10th_percentile": 2146.51, "90th_percentile": 2146.51, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2132.72, "10th_percentile": 2132.72, "90th_percentile": 2132.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2430.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8828.0, "minimum": 7327.61, "maximum": 26516.4272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 15060.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18485.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14788.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18939.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7327.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8828.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18939.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8828.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11377.48 } ] } ] }, { "description": "96522 REFILL & MAIN IMPLNT PUMP", "code_information": [ { "code": "96522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.75, "discounted_cash": 209.0, "minimum": 65.025, "maximum": 216.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 216.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 216.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11010 O DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS (RH)", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2232.5, "discounted_cash": 698.0, "minimum": 558.6, "maximum": 2232.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2232.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2232.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2232.5, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "IGF Binding Protein-3", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.75, "discounted_cash": 14.0, "minimum": 13.7218, "maximum": 106.166, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC RESECT FOREARM WRIST TUM 3CM ASC", "code_information": [ { "code": "25078", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3434.5, "discounted_cash": 2866.0, "minimum": 1030.35, "maximum": 3434.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3434.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3434.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3434.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3434.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15185.0, "minimum": 12290.9, "maximum": 66370.0695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 27365.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33590.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 26872.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39662.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12290.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39662.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20674.09 } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITHOUT CCMCC", "code_information": [ { "code": "798", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8327.0, "minimum": 6701.23, "maximum": 22057.4079, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 19856.73, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14961.44, "10th_percentile": 14961.44, "90th_percentile": 14961.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14089.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17294.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 13835.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6701.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8327.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8327.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10644.56 } ] } ] }, { "description": "MRI Thoracic Spine w+wo Contrast", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2556.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2229.268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1717.97, "10th_percentile": 1717.97, "90th_percentile": 1717.97, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1987.42, "10th_percentile": 1987.42, "90th_percentile": 1987.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1950.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 858.24, "10th_percentile": 858.24, "90th_percentile": 858.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2249.72, "10th_percentile": 2249.72, "90th_percentile": 2249.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5353.0, "minimum": 3872.48, "maximum": 13321.3498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 8333.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10229.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 8183.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9083.19 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 13290.8, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 10110.08, "10th_percentile": 10110.08, "90th_percentile": 10110.08, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3872.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5353.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9083.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 13321.35, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13906.12, "10th_percentile": 13906.12, "90th_percentile": 13906.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 5353.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6295.98 } ] } ] }, { "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", "discounted_cash": 319.0, "minimum": 319.748, "maximum": 1530.218, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1461.1, "10th_percentile": 1461.1, "90th_percentile": 1461.1, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1690.26, "10th_percentile": 1690.26, "90th_percentile": 1690.26, "count": "1 through 10" } ] } ] }, { "description": "21552 O EXC NECK LES 3CM (RH)", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3700.5, "discounted_cash": 2866.0, "minimum": 1110.15, "maximum": 3700.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3700.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3700.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3700.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3700.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Convert Ext Biliary Drain Cath 47535", "code_information": [ { "code": "47535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12509.5, "discounted_cash": 3532.0, "minimum": 3532.78, "maximum": 12509.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12509.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12509.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12509.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Facial Bones 3-4 Views", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 456.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 456.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 456.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 102.92, "10th_percentile": 102.92, "90th_percentile": 102.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Tips Revision 37183", "code_information": [ { "code": "37183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52901.75, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 46130.326, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26875.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "51703 O INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED (RH)", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.25, "discounted_cash": 126.0, "minimum": 126.95, "maximum": 477.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 477.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 477.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 477.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DEBRIDE SKIN TO BONE FAC", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.5, "discounted_cash": 1629.0, "minimum": 304.35, "maximum": 1241.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1898.64, "10th_percentile": 1898.64, "90th_percentile": 1898.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1014.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Triiodothyronine (T3), Reverse", "code_information": [ { "code": "84482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.25, "discounted_cash": 15.0, "minimum": 15.3156, "maximum": 150.202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 115.75, "10th_percentile": 115.75, "90th_percentile": 115.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "B-Cell Receptor IGH Gene Rearrangement, PCR", "code_information": [ { "code": "81261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 700.0, "discounted_cash": 197.0, "minimum": 192.4067, "maximum": 700.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 240.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 192.41, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PANCREAS TRANSPLANT", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55621.0, "minimum": 53414.4, "maximum": 155186.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 105637.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 129663.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 103730.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 155185.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55183.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55621.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 155186.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 55621.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79805.84 } ] } ] }, { "description": "75605 FAC THORACIC AORTOGRAM", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6666.25, "discounted_cash": 5490.0, "minimum": 599.6067, "maximum": 6666.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6666.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6666.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6666.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 599.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6666.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MA Galactogram Single Duct Right Digital", "code_information": [ { "code": "77053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.5, "discounted_cash": 235.0, "minimum": 127.95, "maximum": 426.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 426.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 426.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 426.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 324.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "46220 O EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS (RH)", "code_information": [ { "code": "46220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1176.75, "discounted_cash": 1180.0, "minimum": 353.025, "maximum": 1176.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1214.74, "10th_percentile": 1214.74, "90th_percentile": 1214.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1176.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FB DENTAL SOFT TISSUE FAC", "code_information": [ { "code": "41805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1789.5, "discounted_cash": 1530.0, "minimum": 536.85, "maximum": 1789.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1789.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1789.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1789.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1789.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Von Willebrand Factor Activity", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.5, "discounted_cash": 22.0, "minimum": 22.2931, "maximum": 273.372, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hemochromatosis Mutation-PCR", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.75, "discounted_cash": 65.0, "minimum": 63.5168, "maximum": 335.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.39, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 184.59, "10th_percentile": 184.59, "90th_percentile": 184.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 342.96, "10th_percentile": 342.96, "90th_percentile": 342.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 110.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "30901 O CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE (RH)", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653.75, "discounted_cash": 131.0, "minimum": 109.05, "maximum": 628.2188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 628.22, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SC Therapy Infusion Up to 1 Hr OBS", "code_information": [ { "code": "96369", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 604.75, "discounted_cash": 209.0, "minimum": 181.425, "maximum": 604.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 604.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 604.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 604.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36221 FAC ANGIO THOR AORTA EXT CRAN", "code_information": [ { "code": "36221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7345.5, "discounted_cash": 3115.0, "minimum": 2203.65, "maximum": 7345.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7345.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7345.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7345.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RBC Deglyc", "code_information": [ { "code": "P9039", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2196.75, "discounted_cash": 311.0, "minimum": 311.47, "maximum": 1915.566, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1227.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1490.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1192.53, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 339.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 526.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "27618 O EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM (RH)", "code_information": [ { "code": "27618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2742.75, "discounted_cash": 1629.0, "minimum": 822.825, "maximum": 2742.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2742.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2742.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2742.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2742.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rad Ther Room Level 3", "code_information": [ { "code": "99213", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "minimum": 60.975, "maximum": 192.712, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 177.23, "10th_percentile": 177.23, "90th_percentile": 177.23, "count": "1 through 10" } ] } ] }, { "description": "HB ASC TREAT FINGER DISLOCATION ASC", "code_information": [ { "code": "26785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "40808 O BIOPSY VESTIBULE MOUTH (RH)", "code_information": [ { "code": "40808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.5, "discounted_cash": 532.0, "minimum": 335.55, "maximum": 1118.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1118.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1118.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Cerebrospinal Fluid Leakage", "code_information": [ { "code": "78650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 990.0, "discounted_cash": 1277.0, "minimum": 297.0, "maximum": 990.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 990.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Arthrogram Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 578.25, "discounted_cash": 344.0, "minimum": 173.475, "maximum": 578.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 388.58, "10th_percentile": 388.58, "90th_percentile": 388.58, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 578.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 578.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 578.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 449.53, "10th_percentile": 449.53, "90th_percentile": 449.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 504.23, "10th_percentile": 504.23, "90th_percentile": 504.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 578.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "25560 O CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN (RH)", "code_information": [ { "code": "25560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1986.0, "discounted_cash": 243.0, "minimum": 96.975, "maximum": 1731.792, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37280 REVSC EVSC TPVT ANGIO SF 1st FAC", "code_information": [ { "code": "37280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44700.25, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 44700.25, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44700.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44700.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [ { "code": "368", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13155.0, "minimum": 11558.62, "maximum": 29331.764, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 23435.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28765.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 23012.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22146.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11558.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22146.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17704.6 } ] } ] }, { "description": "64632 O DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE (RH)", "code_information": [ { "code": "64632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 599.5, "discounted_cash": 302.0, "minimum": 179.85, "maximum": 599.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 599.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 599.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 599.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Myco. tb Amplified Direct Detection", "code_information": [ { "code": "87556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.0, "discounted_cash": 41.0, "minimum": 40.5046, "maximum": 342.696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "76857 O US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U (RH)", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 565.492, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 52.61, "10th_percentile": 52.61, "90th_percentile": 105.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 373.11, "10th_percentile": 373.11, "90th_percentile": 373.11, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 448.85, "10th_percentile": 431.65, "90th_percentile": 448.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 28.0, "minimum": 25.05, "maximum": 83.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 83.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10997.0, "minimum": 8794.93, "maximum": 36011.0346, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19258.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23638.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 18911.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19900.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8794.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10997.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19900.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10997.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14549.38 } ] } ] }, { "description": "Occ Med Hepatitis B Core Antibody, Total", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 100.498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 87.0, "10th_percentile": 53.86, "90th_percentile": 87.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 73.41, "10th_percentile": 73.41, "90th_percentile": 146.82, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 77.53, "10th_percentile": 74.56, "90th_percentile": 77.53, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 95.7, "10th_percentile": 95.7, "90th_percentile": 95.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SLP Speech AAC Eval First Hour Units", "code_information": [ { "code": "92607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.5, "discounted_cash": 117.0, "minimum": 95.0, "maximum": 445.156, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 198.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INJ ANES PERIPH NV FAC", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1318.25, "discounted_cash": 696.0, "minimum": 72.375, "maximum": 1318.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1318.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1318.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1318.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Alpha-1 Antitrypsin Phenotype", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 289.75, "discounted_cash": 14.0, "minimum": 14.0522, "maximum": 252.662, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 184.57, "10th_percentile": 184.57, "90th_percentile": 184.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 194.91, "10th_percentile": 194.91, "90th_percentile": 194.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 14.46, "10th_percentile": 14.46, "90th_percentile": 252.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIV-1,2 Confirmation", "code_information": [ { "code": "86689", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 259.75, "discounted_cash": 19.0, "minimum": 18.8043, "maximum": 226.502, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.07, "10th_percentile": 156.07, "90th_percentile": 156.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 174.73, "10th_percentile": 174.73, "90th_percentile": 174.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11603 O EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/< (RH)", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1200.75, "discounted_cash": 698.0, "minimum": 360.225, "maximum": 1200.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1200.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1200.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1200.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "82272 O BLD OCCULT DIGTL EX (RH)", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.25, "discounted_cash": 4.0, "minimum": 4.1107, "maximum": 38.368, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 18.91, "10th_percentile": 18.91, "90th_percentile": 18.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 38.37, "10th_percentile": 38.37, "90th_percentile": 38.37, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXCISION NAIL FOLD FAC", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.0, "discounted_cash": 401.0, "minimum": 91.2, "maximum": 509.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 23.0, "minimum": 22.3903, "maximum": 127.094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MRI Gadolinium per ml", "code_information": [ { "code": "A9579", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.5, "minimum": 3.2035, "maximum": 10.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 118.44, "10th_percentile": 78.96, "90th_percentile": 157.92, "count": "15" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 184.72, "10th_percentile": 184.72, "90th_percentile": 184.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 143.01, "10th_percentile": 95.34, "90th_percentile": 190.68, "count": "53" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 186.12, "10th_percentile": 93.06, "90th_percentile": 279.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 103.4, "10th_percentile": 103.4, "90th_percentile": 163.5, "count": "1 through 10" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CCMCC", "code_information": [ { "code": "842", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8732.0, "minimum": 7280.55, "maximum": 31557.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14874.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18257.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14606.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31557.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7280.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31557.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8732.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11237.35 } ] } ] }, { "description": "TX TALUS FX MANI FAC", "code_information": [ { "code": "28435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1806.25, "discounted_cash": 1586.0, "minimum": 541.875, "maximum": 1806.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1806.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1806.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1806.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1806.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PT Physical Performance Test", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "discounted_cash": 32.0, "minimum": 31.2337, "maximum": 144.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.23, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "37238 FAC TRNSCATH PLC INTVASC STNT INITL VEIN", "code_information": [ { "code": "37238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31315.0, "discounted_cash": 11390.0, "minimum": 9394.5, "maximum": 31315.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31315.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31315.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31315.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "75822 FAC VENOGRAPHY EXT BILATERAL", "code_information": [ { "code": "75822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2650.75, "discounted_cash": 1553.0, "minimum": 576.2288, "maximum": 2650.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2650.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2650.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2650.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 576.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Iodine I-123 Ioflupane Up To 5 mCi", "code_information": [ { "code": "A9584", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10167.5, "discounted_cash": 1387.0, "minimum": 1387.74, "maximum": 8866.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6445.82, "10th_percentile": 6445.82, "90th_percentile": 6445.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5467.14, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6641.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5313.24, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5412.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1512.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1388.02, "10th_percentile": 1388.02, "90th_percentile": 1388.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2346.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "42860 O EXC TONSIL TAGS (RH)", "code_information": [ { "code": "42860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1447.25, "discounted_cash": 3271.0, "minimum": 434.175, "maximum": 1447.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1447.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC REPAIR OF LEG TENDON WO GRAFT EACH ASC", "code_information": [ { "code": "27658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 8748.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "5HIAA, Urine Random", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.25, "discounted_cash": 12.0, "minimum": 12.5362, "maximum": 128.402, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 129.58, "10th_percentile": 129.58, "90th_percentile": 129.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC CORRECTION OF BUNION W DIST OSTEO ASC", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 3359.87, "10th_percentile": 3359.87, "90th_percentile": 3359.87, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93260 FAC PRGRM SUBQ LEAD DEFIB SYS", "code_information": [ { "code": "93260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.75, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 127.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 127.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "68815 H LACRIMAL DUCT REP W/STENT (RH)", "code_information": [ { "code": "68815", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 729.5, "discounted_cash": 2345.0, "minimum": 218.85, "maximum": 729.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 729.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11620 O EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/< (RH)", "code_information": [ { "code": "11620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1229.0, "discounted_cash": 1629.0, "minimum": 368.7, "maximum": 1229.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1229.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "29550 O STRAPPING TOES (RH)", "code_information": [ { "code": "29550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.5, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 197.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 197.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 197.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 197.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "96415 O CHEMO IV INFUS EA A (RH)", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.5, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 254.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 195.27, "10th_percentile": 187.7, "90th_percentile": 195.27, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 254.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 254.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 254.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 181.68, "10th_percentile": 181.68, "90th_percentile": 381.38, "count": "18" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 195.27, "10th_percentile": 187.7, "90th_percentile": 195.27, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 381.38, "10th_percentile": 27.55, "90th_percentile": 437.8, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Osteocalcin", "code_information": [ { "code": "83937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.75, "discounted_cash": 29.0, "minimum": 29.0082, "maximum": 314.574, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.48, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Repair CVAD wo Port", "code_information": [ { "code": "36575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1236.75, "discounted_cash": 618.0, "minimum": 371.025, "maximum": 1236.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1236.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "0795T FAC TCAT INS 2 CHAMBER LDLS PM COMP", "code_information": [ { "code": "0795T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57213.5, "discounted_cash": 19005.0, "minimum": 17164.05, "maximum": 57213.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57213.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57213.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57213.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20716.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32142.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "67700 O BLEPHAROTOMY DRAINAGE ABSCESS EYELID (RH)", "code_information": [ { "code": "67700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.5, "discounted_cash": 313.0, "minimum": 124.35, "maximum": 1222.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1222.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1222.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1199.07, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 341.37, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 529.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Sodium, Stool", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.0, "discounted_cash": 4.0, "minimum": 4.7229, "maximum": 61.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10322.0, "minimum": 8599.06, "maximum": 47613.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17952.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22036.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 17628.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47613.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8599.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10322.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47613.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10322.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13562.89 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7508.0, "minimum": 5667.88, "maximum": 15348.5221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 12504.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15348.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 12278.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10961.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5667.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7508.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10961.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7508.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9446.75 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [ { "code": "844", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10306.0, "minimum": 8272.37, "maximum": 21998.2232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 17921.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21998.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 17598.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20582.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8272.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10306.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20582.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10306.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13539.53 } ] } ] }, { "description": "Trichomonas, Wet Mount", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.5, "discounted_cash": 5.0, "minimum": 5.6559, "maximum": 61.476, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Guided Needle Biopsy-Aspiration", "code_information": [ { "code": "77012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1778.75, "minimum": 533.625, "maximum": 1551.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 226.67, "10th_percentile": 226.67, "90th_percentile": 226.67, "count": "1 through 10" }, { "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": 76.27, "median_amount": 1153.15, "10th_percentile": 1153.15, "90th_percentile": 1356.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 620.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1476.64, "10th_percentile": 1476.64, "90th_percentile": 1476.64, "count": "1 through 10" } ] } ] }, { "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": 28.0, "minimum": 28.53, "maximum": 113.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RPR FLEXOR TEND LEG FAC", "code_information": [ { "code": "27658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8748.75, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 8748.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8748.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8748.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8748.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Insert Subq Car Rhythm Monitor & Prgm", "code_information": [ { "code": "33285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34295.0, "discounted_cash": 8165.0, "minimum": 8165.34, "maximum": 34295.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32168.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34295.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31262.64, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Punch BX Skin 1st Lesn", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 919.5, "discounted_cash": 401.0, "minimum": 107.4, "maximum": 919.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 919.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 919.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 919.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "donotorder_ST GI Pan PCR", "code_information": [ { "code": "87507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.25, "discounted_cash": 416.0, "minimum": 213.375, "maximum": 711.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 506.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 454.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 704.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "758", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8493.0, "minimum": 7054.91, "maximum": 26007.8726, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 14412.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17690.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 14152.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11717.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7054.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8493.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11717.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 8493.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10888.12 } ] } ] }, { "description": "HB ASC REPAIR ELBOW W DEB OPEN ASC", "code_information": [ { "code": "24358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 4192.67, "10th_percentile": 4192.67, "90th_percentile": 4192.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Head Code Stroke", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1560.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1360.538, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 959.28, "10th_percentile": 270.03, "90th_percentile": 1142.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 76.27, "median_amount": 1109.74, "10th_percentile": 1109.74, "90th_percentile": 1154.16, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 605.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 270.26, "10th_percentile": 270.26, "90th_percentile": 270.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1256.2, "10th_percentile": 1256.2, "90th_percentile": 1319.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 794.0, "minimum": 203.7, "maximum": 679.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 679.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 679.0, "10th_percentile": 679.0, "90th_percentile": 679.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 679.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Unlisted Dx Nervous Nuc Med Proc", "code_information": [ { "code": "78699", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1401.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1401.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1401.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1401.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "072", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6799.0, "minimum": 5192.38, "maximum": 24319.8903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11132.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13664.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 10931.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13198.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5192.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6799.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13198.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6799.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8410.21 } ] } ] }, { "description": ".dRVVT Confirm", "code_information": [ { "code": "85597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.75, "discounted_cash": 17.0, "minimum": 17.473, "maximum": 144.534, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med CONTRACT RATE DOT Physical", "code_information": [ { "code": "99455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.0, "minimum": 45.0, "maximum": 170.258, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Meningitis/Encephalitis PCR Panel, CSF", "code_information": [ { "code": "87483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.25, "discounted_cash": 416.0, "minimum": 213.375, "maximum": 711.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 506.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 711.25, "10th_percentile": 711.25, "90th_percentile": 711.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 454.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 704.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "17250 O CHEMICAL CAUTERIZATION GRANULATION TISSUE (RH)", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.5, "discounted_cash": 197.0, "minimum": 90.75, "maximum": 648.75, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 302.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 302.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 302.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 302.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "53661 O DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ (RH)", "code_information": [ { "code": "53661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.25, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 491.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 491.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 491.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 491.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "653", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40568.0, "minimum": 38583.65, "maximum": 93898.1166, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 76498.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 93898.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 75118.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 79284.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38583.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40568.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79284.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 40568.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57792.7 } ] } ] }, { "description": "Bill IRL Cold Agg Screen", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.5, "discounted_cash": 8.0, "minimum": 7.8424, "maximum": 135.596, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "I-D ABSCESS SIMPLE FAC", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 197.0, "minimum": 167.625, "maximum": 646.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 425.8, "10th_percentile": 357.67, "90th_percentile": 425.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 426.16, "10th_percentile": 426.16, "90th_percentile": 426.16, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 438.62, "10th_percentile": 438.62, "90th_percentile": 438.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 468.38, "10th_percentile": 192.31, "90th_percentile": 487.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BhCG Quant", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.75, "discounted_cash": 15.0, "minimum": 14.6256, "maximum": 145.406, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 112.06, "10th_percentile": 112.06, "90th_percentile": 133.4, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 106.22, "10th_percentile": 106.22, "90th_percentile": 106.22, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 112.17, "10th_percentile": 112.17, "90th_percentile": 114.32, "count": "20" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 67.27, "10th_percentile": 67.27, "90th_percentile": 133.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 145.41, "10th_percentile": 78.97, "90th_percentile": 146.74, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TX TOE JT DISLOCATE FAC", "code_information": [ { "code": "28660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.0, "discounted_cash": 243.0, "minimum": 105.9, "maximum": 728.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Drug Monitoring, Phosphatatidylethanol (Peth), Blood MCR", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 382.5, "discounted_cash": 114.0, "minimum": 84.675, "maximum": 382.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "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": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 218.68, "10th_percentile": 114.43, "90th_percentile": 624.59, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INT REP FACE <2.5 FAC", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 401.0, "minimum": 167.625, "maximum": 1708.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 558.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC CERVICAL RHIZOTOMY 1 FACET ASC", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2664.5, "discounted_cash": 1926.0, "minimum": 756.0, "maximum": 2664.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2664.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2664.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2664.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 748.18, "10th_percentile": 748.18, "90th_percentile": 748.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2100.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3734.42, "10th_percentile": 3734.42, "90th_percentile": 3734.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2664.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5869.0, "minimum": 4875.38, "maximum": 13710.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 9333.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11456.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 9165.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13710.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4875.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13710.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 5869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7051.15 } ] } ] }, { "description": "Pulmonary Rehab Group RT MCR MCR", "code_information": [ { "code": "G0239", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.0, "discounted_cash": 36.0, "minimum": 32.4, "maximum": 108.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CT Ankle Left w Contrast", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.0, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1512.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "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": 1023.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1382.56, "10th_percentile": 1382.56, "90th_percentile": 1382.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "61070 O PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX (RH)", "code_information": [ { "code": "61070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 674.5, "discounted_cash": 696.0, "minimum": 202.35, "maximum": 1961.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 674.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [ { "code": "175", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11494.0, "minimum": 9752.85, "maximum": 34748.0019, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 31281.17, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16149.72, "10th_percentile": 16149.72, "90th_percentile": 16149.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 20221.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24820.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 19856.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20202.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9752.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11494.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20202.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11494.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15276.74 } ] } ] }, { "description": "28810 FAC AMPUTATE METARTASAL W/TOE", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5688.0, "discounted_cash": 3228.0, "minimum": 1041.9, "maximum": 5688.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5688.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5688.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5688.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Injection Therapy SC/IM", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.25, "discounted_cash": 71.0, "minimum": 17.475, "maximum": 135.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 111.89, "10th_percentile": 90.89, "90th_percentile": 133.2, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 104.01, "10th_percentile": 103.2, "90th_percentile": 117.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 103.68, "10th_percentile": 103.68, "90th_percentile": 518.42, "count": "16" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 130.7, "10th_percentile": 106.17, "90th_percentile": 321.35, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 115.47, "10th_percentile": 68.88, "90th_percentile": 235.88, "count": "58" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Parvovirus B19 Ab IgG", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.75, "discounted_cash": 15.0, "minimum": 14.6062, "maximum": 353.814, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "XR Foot Left 3 Views", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.5, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 392.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 296.2, "10th_percentile": 248.81, "90th_percentile": 296.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 392.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 248.85, "10th_percentile": 234.74, "90th_percentile": 248.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 299.36, "10th_percentile": 287.83, "90th_percentile": 299.36, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 102.59, "10th_percentile": 102.59, "90th_percentile": 296.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 325.82, "10th_percentile": 325.82, "90th_percentile": 325.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10798.0, "minimum": 9204.68, "maximum": 27725.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 18872.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23165.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 18532.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27724.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9204.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27725.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 10798.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14257.99 } ] } ] }, { "description": "PLEURAL EFFUSION WITH MCC", "code_information": [ { "code": "186", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12901.0, "minimum": 10935.7, "maximum": 28161.8456, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22943.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28161.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 22529.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25546.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10935.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12901.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25546.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12901.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17333.14 } ] } ] }, { "description": "Prostatic Acid Phosphatase", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 9.0, "minimum": 9.3876, "maximum": 188.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Protein S Antigen, Total and Free", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.5, "discounted_cash": 11.0, "minimum": 11.2826, "maximum": 55.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1759) CATH, INTRA ECHOCARDIOGRAPHY", "code_information": [ { "code": "C1759", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1172.14, "10th_percentile": 1172.14, "90th_percentile": 2793.0, "count": "1 through 10" } ] } ] }, { "description": "XR SI Joint Injection 27096 MCR MCR", "code_information": [ { "code": "G0260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.0, "discounted_cash": 696.0, "minimum": 61.8, "maximum": 613.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1462.6, "10th_percentile": 480.0, "90th_percentile": 3128.13, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 863.13, "10th_percentile": 863.13, "90th_percentile": 863.13, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC PARTIAL REMOVAL OF FOOT BONE ASC", "code_information": [ { "code": "28288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1183.2, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 302.584, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.79, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.63, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 182.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "24105 O EXCISION OLECRANON BURSA (RH)", "code_information": [ { "code": "24105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2634.0, "discounted_cash": 3228.0, "minimum": 790.2, "maximum": 2634.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2634.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [ { "code": "336", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17085.0, "minimum": 14619.93, "maximum": 50074.5336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 31043.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38103.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 30483.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37768.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14619.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37768.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 17085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23452.29 } ] } ] }, { "description": "IR Lymphangiogram Pelvic-Abd Bilat", "code_information": [ { "code": "75807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1581.75, "discounted_cash": 3115.0, "minimum": 474.525, "maximum": 1581.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1581.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1581.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [ { "code": "651", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29232.0, "minimum": 24034.32, "maximum": 322430.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 54555.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 66963.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 53570.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 322429.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24034.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 322430.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 29232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41214.72 } ] } ] }, { "description": "HB ASC DEBRIDE SKIN MUSCLE FX ASC", "code_information": [ { "code": "11011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1083.25, "discounted_cash": 698.0, "minimum": 324.975, "maximum": 1868.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1083.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1083.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1083.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1083.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "90675 RABIES VAC IM HUMAN - AMB RABIES Human (RH)", "code_information": [ { "code": "90675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1729.5, "discounted_cash": 319.0, "minimum": 319.748, "maximum": 1530.218, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1461.1, "10th_percentile": 1461.1, "90th_percentile": 1461.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1259.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1530.22, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1224.22, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1690.26, "10th_percentile": 1690.26, "90th_percentile": 1690.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 682.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 348.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 540.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Dose Sestamibi", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.75, "minimum": 97.725, "maximum": 284.054, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.11 } ] } ] }, { "description": "NM Inj Sentinel Node Right 38792", "code_information": [ { "code": "38792", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1173.0, "discounted_cash": 394.0, "minimum": 351.9, "maximum": 1173.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1173.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1173.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1173.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 894.65, "10th_percentile": 894.65, "90th_percentile": 911.89, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 929.02, "10th_percentile": 929.02, "90th_percentile": 929.02, "count": "1 through 10" } ] } ] }, { "description": "Occ Med $ Complete Blood Count with Differential 85025", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 7.5509, "maximum": 82.186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 71.2, "10th_percentile": 59.81, "90th_percentile": 71.2, "count": "234" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 9.44, "10th_percentile": 9.44, "90th_percentile": 9.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 60.04, "10th_percentile": 56.69, "90th_percentile": 82.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 34.73, "10th_percentile": 17.97, "90th_percentile": 71.2, "count": "132" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 78.32, "10th_percentile": 40.77, "90th_percentile": 82.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LD (Lactate Dehydrogenase)", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 6.0, "minimum": 5.8697, "maximum": 88.944, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 68.54, "10th_percentile": 68.54, "90th_percentile": 68.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 64.97, "10th_percentile": 64.97, "90th_percentile": 84.46, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 68.62, "10th_percentile": 68.62, "90th_percentile": 68.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 88.94, "10th_percentile": 6.04, "90th_percentile": 89.76, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "36905 FAC THRMBC/NFS DIALYSIS CIRCUIT W TRANS THROMB", "code_information": [ { "code": "36905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35806.0, "discounted_cash": 11390.0, "minimum": 10741.8, "maximum": 35806.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35806.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35806.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35806.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [ { "code": "005", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 79463.0, "minimum": 73708.01, "maximum": 233541.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 151786.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 186309.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 149047.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 233540.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73708.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 79463.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 233541.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 79463.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 114670.08 } ] } ] }, { "description": "11621 O EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM (RH)", "code_information": [ { "code": "11621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069.75, "discounted_cash": 698.0, "minimum": 320.925, "maximum": 1069.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1069.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1069.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1069.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1069.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [ { "code": "058", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14049.0, "minimum": 12776.08, "maximum": 51748.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 25166.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30890.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 24712.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51748.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12776.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51748.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 14049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19012.51 } ] } ] }, { "description": "XR Chest 3 Views 71047", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.25, "discounted_cash": 85.0, "minimum": 76.575, "maximum": 255.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 255.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Radiopharm Tx Unlisted Procedure", "code_information": [ { "code": "79999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1329.5, "discounted_cash": 230.0, "minimum": 230.23, "maximum": 1159.324, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 907.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1101.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 881.48, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 389.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "15620 O DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F (RH)", "code_information": [ { "code": "15620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2944.25, "discounted_cash": 2035.0, "minimum": 883.275, "maximum": 2944.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2944.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2944.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2944.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2944.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "90371 O HEP B IMM GL HBIG 3 (RH)", "code_information": [ { "code": "90371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 725.5, "discounted_cash": 137.0, "minimum": 137.828, "maximum": 659.6035, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 137.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 233.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 542.99, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 659.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 527.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 137.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.23, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HB ASC OPEN TREAT FINGER FRACTURE EACH ASC", "code_information": [ { "code": "26735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 4508.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Replace Tunneled CVAD w Pump", "code_information": [ { "code": "36583", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7169.75, "discounted_cash": 5490.0, "minimum": 2150.925, "maximum": 7169.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7169.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7169.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7169.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7169.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Coronary Risk Panel", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 13.0, "minimum": 12.0, "maximum": 172.656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.4, "10th_percentile": 125.5, "90th_percentile": 149.4, "count": "257" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 121.03, "10th_percentile": 34.09, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 127.81, "10th_percentile": 122.89, "90th_percentile": 133.19, "count": "404" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.85, "10th_percentile": 59.85, "90th_percentile": 143.4, "count": "126" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 157.74, "10th_percentile": 70.26, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC AMPUTATION OF FINGER THUMB W DIR CLOSE ASC", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4508.25, "discounted_cash": 3228.0, "minimum": 1352.475, "maximum": 6773.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 3438.44, "10th_percentile": 3438.44, "90th_percentile": 3438.44, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4508.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11002.0, "minimum": 8713.26, "maximum": 24568.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 19267.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23649.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 18919.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24568.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8713.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24568.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 11002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14556.05 } ] } ] }, { "description": "Reducing Substances, Fecal", "code_information": [ { "code": "84376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.5, "discounted_cash": 5.0, "minimum": 5.3449, "maximum": 28.8596, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13837.0, "minimum": 12028.58, "maximum": 39230.9772, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 24755.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30386.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 24308.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32890.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12028.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32890.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13837.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18702.22 } ] } ] }, { "description": "Mixed Blood Gas", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.25, "discounted_cash": 26.0, "minimum": 25.3348, "maximum": 260.074, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Occ Med Urine, Drug Panel 7 with Confirmation", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 62.0, "minimum": 12.0, "maximum": 258.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 163.8, "10th_percentile": 154.0, "90th_percentile": 277.77, "count": "21" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 470.66, "10th_percentile": 470.66, "90th_percentile": 470.66, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 173.89, "10th_percentile": 99.58, "90th_percentile": 333.49, "count": "51" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 258.5, "10th_percentile": 195.0, "90th_percentile": 258.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 134.29, "10th_percentile": 134.29, "90th_percentile": 470.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "69300 O OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTN (RH)", "code_information": [ { "code": "69300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3892.75, "discounted_cash": 3271.0, "minimum": 1167.825, "maximum": 3892.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3892.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3892.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3892.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3565.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3892.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6977.0, "minimum": 5400.71, "maximum": 20179.9892, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 18166.62, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9122.63, "10th_percentile": 9122.63, "90th_percentile": 20978.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11476.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14087.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 11269.79 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 17171.5, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8710.7, "10th_percentile": 8710.7, "90th_percentile": 8710.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 17650.55, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7477.25, "10th_percentile": 7477.25, "90th_percentile": 23030.52, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12781.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5400.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12781.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 20179.99, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6342.82, "10th_percentile": 6330.69, "90th_percentile": 15526.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 6977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8670.46 } ] } ] }, { "description": "TX STERNOCLAV DISLOC FAC", "code_information": [ { "code": "23520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.75, "discounted_cash": 1586.0, "minimum": 72.225, "maximum": 1812.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HB ASC EXCISION TENDON FINGER FLEXOR/EXTENSOR EA ASC", "code_information": [ { "code": "26180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2431.0, "discounted_cash": 1586.0, "minimum": 729.3, "maximum": 2431.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2431.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2431.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2431.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2431.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "IR Embolization Intracranial", "code_information": [ { "code": "61624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5064.0, "discounted_cash": 18087.0, "minimum": 1519.2, "maximum": 5064.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5064.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PT Evaluation Units, High Complexity", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.75, "discounted_cash": 94.0, "minimum": 91.4172, "maximum": 366.894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.42, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PFT Full", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 461.5, "discounted_cash": 368.0, "minimum": 10.2, "maximum": 461.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 351.6, "10th_percentile": 351.6, "90th_percentile": 351.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 461.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 461.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 461.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 337.98, "10th_percentile": 337.98, "90th_percentile": 352.12, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 351.99, "10th_percentile": 341.67, "90th_percentile": 351.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 336.92, "10th_percentile": 336.92, "90th_percentile": 353.79, "count": "11" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 348.08, "10th_percentile": 348.08, "90th_percentile": 348.08, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 301.39, "10th_percentile": 301.39, "90th_percentile": 402.43, "count": "34" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "21931 O EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/> (RH)", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3932.5, "discounted_cash": 1629.0, "minimum": 1179.75, "maximum": 3932.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3932.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3932.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3932.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1735.0, "10th_percentile": 1735.0, "90th_percentile": 6896.27, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "45317 O PRCTSIGSCPY/CNTRL (RH)", "code_information": [ { "code": "45317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1181.75, "discounted_cash": 1180.0, "minimum": 354.525, "maximum": 1181.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1181.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1181.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1181.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1181.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1180.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NM Y90 Mapping 78201", "code_information": [ { "code": "78201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1364.0, "discounted_cash": 535.0, "minimum": 409.2, "maximum": 1364.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1364.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1364.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1364.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 901.31, "10th_percentile": 901.31, "90th_percentile": 901.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1364.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "93571-LD FAC FLOW WIRE", "code_information": [ { "code": "93571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 979.75, "minimum": 293.925, "maximum": 854.342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 775.96, "10th_percentile": 775.96, "90th_percentile": 775.96, "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": 18.0, "minimum": 18.0172, "maximum": 93.1903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Mycobacteria ID using 16S DNA Sequencing", "code_information": [ { "code": "87153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 672.75, "discounted_cash": 115.0, "minimum": 112.1068, "maximum": 605.317, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.13, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 605.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 195.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5739.0, "minimum": 4319.6, "maximum": 52203.1607, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 9081.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11147.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 8917.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10797.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4319.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5739.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10797.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 5739.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6860.96 } ] } ] }, { "description": "MA US Elastography 1st Lesion 76982", "code_information": [ { "code": "76982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 542.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NEUROLOGICAL EYE DISORDERS", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7121.0, "minimum": 5559.21, "maximum": 37875.395, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 11756.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14430.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 11544.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14382.7 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 37788.52, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13943.11, "10th_percentile": 13943.11, "90th_percentile": 13943.11, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5559.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14382.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 7121.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8881.77 } ] } ] }, { "description": "90636 HEP A/B VAC ADLT IM (RH)", "code_information": [ { "code": "90636", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.5, "minimum": 187.35, "maximum": 544.564, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.88 } ] } ] }, { "description": "HC (SUP SHELL C1726) CATHETER BALLOON DILAT NON-VASCULAR", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 829.82, "10th_percentile": 829.82, "90th_percentile": 1580.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 834.06, "10th_percentile": 764.11, "90th_percentile": 834.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 834.06, "10th_percentile": 834.06, "90th_percentile": 948.74, "count": "1 through 10" } ] } ] }, { "description": "Cmv antibody", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.0, "discounted_cash": 14.0, "minimum": 13.9842, "maximum": 157.832, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 125.4, "10th_percentile": 125.4, "90th_percentile": 125.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "905", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 11407.74, "maximum": 32081.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 21837.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26804.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21443.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32081.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11407.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12329.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32081.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12329.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16497.9 } ] } ] }, { "description": "93025 FAC MICROVOLT T-WAVE ASSESS", "code_information": [ { "code": "93025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 715.25, "discounted_cash": 126.0, "minimum": 126.95, "maximum": 623.698, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 500.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 607.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 486.05, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "E.coli 0157 Latex (oxoid)", "code_information": [ { "code": "87335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 12.0, "minimum": 9.0, "maximum": 30.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "63650 O PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL (RH)", "code_information": [ { "code": "63650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3232.0, "discounted_cash": 6288.0, "minimum": 969.6, "maximum": 3232.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3232.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "11450 O EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR (RH)", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1625.0, "discounted_cash": 2866.0, "minimum": 487.5, "maximum": 1625.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1625.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "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": 12494.0, "minimum": 10122.45, "maximum": 41690.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 22155.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27195.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 21756.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41690.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10122.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12494.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41690.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 12494.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16738.13 } ] } ] }, { "description": "PATIENT SUPPLIED MED - AMB ETANERCEPT (RH)", "code_information": [ { "code": "J1438", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 0.01, "minimum": 1.0, "maximum": 885.1765, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 885.18 } ] } ] }, { "description": "19355 O CORRECTION INVERTED NIPPLES (RH)", "code_information": [ { "code": "19355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5061.0, "discounted_cash": 3863.0, "minimum": 1518.3, "maximum": 5061.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3863.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5061.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5061.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3863.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5061.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3863.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3863.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4211.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3863.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3863.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3863.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3863.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3863.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5061.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13123.0, "minimum": 10735.67, "maximum": 47523.1629, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 23373.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28689.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "case rate", "standard_charge_dollar": 22951.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27458.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10735.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27458.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "case rate", "standard_charge_dollar": 13123.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17657.89 } ] } ] }, { "description": "Hepatitis B Surface Ag Confirmation", "code_information": [ { "code": "87341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.25, "discounted_cash": 10.0, "minimum": 10.0387, "maximum": 122.298, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "54164 O FRENULOTOMY OF PENIS (RH)", "code_information": [ { "code": "54164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1500.75, "discounted_cash": 2062.0, "minimum": 450.225, "maximum": 1500.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule",